4310 COLBY AVE 300 AND 301 2022-01-14

� PERMIT APPLICATIO BUILDINGAECHANICAL / PLUMBING / SIGN PRINKLER /DEMOLITION EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P) 425-257-8810 1 FAX425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please); P,ROJECT`SITE INFORMATIO"N PROJECT SITE ADDRESS:431 O Colby Avenue I PROPERTY TAX #:00582202600200 LEGAL for new construction: Short Plat/subdivision EI[QLJ 26 __ Lot No.2 (attach copy of long legal description) CO,,,�'�T f`N;FORMATION"' � OWNER NAME: Matana LLC TENANT BUSINESS NAME (Commercial): Providence OWNER MAILING ADDRESS: sTREET117 East Louisa Street, Suite 230 ciTy Seattle STATE WA zip 98102 OWNER PHONE: 206-545-4964 1OWNER EMAIL:Brad@seattleretail.net CONTRACTOR NAME: Ma CONTRACTOR ADDRESS: STREET117 East Louisa Street, Suite 230 crry Seattle STATE WA z.. 98102 CONTRACTOR PHONE:206-545-4964 CONTRACTOR EMAIL:Brad@seattleretail.net CONTRACTOR LICENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): PRIMARY CONTACT: O OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: Brad Decker CONTACT PHONE:206-226-1700 CONTACT EMAIL:Brad@seattleretail.net BUILDING INFORMATION Existing Use of Building: Medical - Dental Contract Price of Work: $15,000.00 Proposed Use of Building: Medical - Dental I Heat Source: ❑Gas ❑Electric OOther BUILDING USE: OSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑✓ Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ZT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: TI for Providence Medical Group - Divide the 3rd floor into two Suites 300 & 301. Improve Suite 301 by by adding two bathrooms and a break/confrence room. ASSOCIATED BUILDING PERMIT # (if applicable): MECHANICAL:PER"MIT APPLICAION ` r " . „ PLUMPING PERMIT APPLICATION Fixture CountList of Fixtures Fixture cosine List of Fixtures fixture Counf List of Fixtures Fixture Counf List of Fix C - Air Handling Units Gas Pipin Backflow Preventer (Inside Bldg) Shower, , or Combo Boiler G ange Qothes Washer Si ommercial (3-comp,prep,floor) Clothes Drye eat Pump&Ductless Dish her Sink -Residential (kitchen, bath, bar) Duct System (Remo Refrigeration Drinking Fo ain Sink -Utility, laundry, mop Exhaust Fans (Resi ial) Commercial Ventilatio Heat/AC system) Floor Drain Toilet Exhaust Hoo pe 1) Hose Bibb Urinal Exhau ood (Type II) Water ter Interceptor -Grease Waste/Water Piping Repair gust Hood (Residential) Wood Stove Interceptor-Sa Oil Water Service (behind meter) Forced Air Systems Other: Medical WS WsWr Valves or Fixtures Gas Fireplace/Insert/Log Roo rains Water er SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System INo. of Heads Chemical Suppression System I No. of Heads ACKNOWLEDGEMENT: I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with current federal, state, and local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the Building Official before being authorized under any circumstance. / am the owner, or 1 am authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PER J� Owner/Authorized Agent Signature Date (Revised 1011012018) '� J I �,