1321 COLBY AVE 4TH FLOOR 2022-01-26

PERMIT APPLICATION • BUILDING /MECHANICAL /PLUMBING /SIGN /SPRINKLER /DEMOLITION EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (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 Ave PROPERTY TAX #: 00438524600000 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Providence Health and Services - Washington TENANT BUSINESS NAME (Commercial): OWNER MAILING ADDRESS: STREET 1321 Colby Ave CITY Everett STATE WA ziP 98201 OWNER PHONE: 425-218-0919 OWNER EMAIL:james.grafton@providence.org CONTRACTOR NAME: M.A. Mortenson Company CONTRACTOR ADDRESS: STREET 10230 NE Points Dr., Suite 300 CITY Kirkland STATE WA ZIP 98033 CONTRACTOR PHONE: 425-497-7023 CONTRACTOR EMAIL: Erin. Erwin@mortenson.com CONTRACTOR LICENSE #(REQUIRED): MAMORC'190N6 CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR I] OTHER (Please Specify) Architect CONTACT NAME: Jill Kurtz CONTACT PHONE: 509-991-9653 CONTACT EMAIL:jkurtz@nacarchitecture.com BUILDING INFORMATION Existing Use of Building: Hospital Contract Price of Work: 0 00 • �' Proposed Use of Building: Hospital Heat Source: OGas ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family- # Units: ❑✓ Commercial ElAccessory Structure Type of Project: ❑New ❑Addition ❑✓ Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Renovation of existing medical inpatient unit for use by behavioral health patients. ASSOCIATED BUILDING PERMIT # (if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Count List o1 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) 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 Ventilatior (Not Heat/AC system) Floor Drain Toilet Exhaust Hood (Type 1) Hose Bibb Urinal Exhaust Hood (Type 11) Water Heater Interceptor -Grease Waste/Water Piping Repair Exhaust Hood (Residential) Wood Stove Interceptor-Sand/Oil Water Service (behind meter) Forced Air Systems Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log I Roof Drains Water Heater SPRINKLER / SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No. of Heads Chemical Suppression System No. of Heads ACKNOWLEDGEMENT: 1 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 / am authorized by the owner of this property to perform the work for which application is made, and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. **�\ 'Ned Agent Si 9-4-2020 Date City of Everett Official Use Only PERT) 00 1 _ D 1^ (Revised 1011012018) Il )k