1321 COLBY AVE 3RD FLOOR 2022-01-26

EVERETT WASHINGTON PERMIT APPLICATIOIRRINKLER BUILDING / MECHANICAL / PLUMBING / SIGN / DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 1321 Colby Avenue, Everett WA 98201 PROPERTY TAX #: 00438524600000 LEGAL for new construction: Short Plat/subdivision See attached Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: PROVIDENCE HEALTH & SERVICES-WASHINGTON TENANT BUSINESS NAME (Commercial): PRMCE 4A Behavioral Health Unit OWNER MAILING ADDRESS: STREET 1801 LIND AVE SW #9016 CITY Renton STATE WA zIP 98057 OWNER PHONE: (425) 525-3514 OWNER EMAIL: Kristen.federici@PROVIDENCE.ORG CONTRACTOR NAME: MacDonald Miller Facility Solutions CONTRACTOR ADDRESS: STREET 7717 Detroit Ave SW CITY Seattle STATE WA ZIP 98106 CONTRACTOR PHONE: (206) 768-4062 CONTRACTOR EMAIL: Permits@macmiller.com CONTRACTOR LICENSE #(REQUIRED): MACDOFS980RU CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 040665 PRIMARY CONTACT: ❑ OWNER 0 CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: Ammone Bembry CONTACT PHONE: (206) 768-4062 CONTACT EMAIL: permits@macmiller.com BUILDING INFORMATION Existing Use of Building: Medical Clinic Contract Price of Work: $ 160,000 Proposed Use of Building: Medical Clinic Heat Source: ❑Gas ❑Electric OQther Medical Gas BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑✓ Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel ❑✓ Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Cut, cap, and drop in place plumbing for level 3 and 4 for the Providence Behavioral Health Unit in Everett. Installing approximately (60) wall outlets for Medical Gas systems including vacuum, air, and oxygen and one zone valve box. Tie-in into (32) lavatory, (6) sinks, (16) water closets, and one shower, per plan. ASSOCIATED BUILDING PERMIT # (if applicable): Building Permit — R2009-017- Mechanical and Plumbing — X2009-001 MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Count List of Fixtures Fixture Count List of Fixtures Fixture Count List of Fixtures Fixture Count List of Fixtures A/C — Air Handling Units Gas Piping Backflow Preventer (Inside Bldg) 1 Shower, Tub, or Combo Boiler Gas Range Clothes Washer Sink -Commercial (3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink -Residential (kitchen, bath, bar) Duct System (Remodel) Refrigeration Drinking Fountain Sink -Utility, laundry, mop Exhaust Fans (Residential) Commercial Ventilation (Not Heat/AC system) 1 Floor Drain 16 Toilet Exhaust Hood (Type I) Hose Bibb Urinal Exhaust Hood (Type II) Water Heater Interceptor -Grease Waste/Water Piping Repair Exhaust Hood (Residential) Wood Stove Interceptor-Sand/Oil Water Service (behind meter) Forced Air Systems Other: 64 Medical Gas Water Valves or Fixtures Gas Fireplace/InserULog I Roof Drains Water Heater SPRINKLER / SUPPRESSION SYSTEM Sewage Ejector or Sump Pump 5 Other: Trap Primer Water Suppression System I INo. of Heads 32 Bathroom Sink/Lav Chemical Suppression System I I No. of Heads 6 Sink 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. I am the owner, or I 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. 10i28/2020 Owner/Authorized Agent Signature Date City of Everett Official Use Only PERMI h , � _ o �2� J (Revised 1011012018) f/ o