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0 PERMIT APPLICATION• <br />BUILDING /MECHANICAL /PLUMBING /SIGN /SPRINKLER /DEMOLITION <br />EVERETT CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) eve retteps(a)everettwa.pov I www.everettwa.aov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 1321 Colby Ave Everett, WA 98201 <br />PROPERTY TAX #: 00438524600000 <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: Providence Health & Services TENANT BUSINESS NAME (Commercial): Providence Behavioral Health Unit <br />OWNER MAILING ADDRESS: STREET 1321 Colby Ave, <br />CITY Everett STATE WA ZIP 98201 <br />OWNER PHONE: 425.261.4210 <br />OWNER EMAIL: <br />CONTRACTOR NAME: McKinstry Co. LLC <br />CONTRACTOR ADDRESS: STREET 5005 3rd Ave S <br />CITY Seattle STATE WA ZIP 98134 <br />CONTRACTOR PHONE: 206.762.3311 <br />CONTRACTOR EMAIL: permits@mckinstry.com <br />CONTRACTOR LICENSE #(REQUIRED): MCKINCL942DW <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 49226 <br />PRIMARY CONTACT: ❑ OWNER EI CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />Robert Fix <br />CONTACT PHONE: 206.790.1091 <br />CONTACT EMAIL: permits@mckinstry.com <br />BUILDING INFORMATION <br />Existing Use of Building: Commercial <br />Contract Price of Work: $ 44671 <br />Proposed Use of Building: Behavioral Health <br />Heat Source: []Gas []Electric ❑Other <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑✓ Commercial ❑Accessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑✓ T.I. ❑Sign []Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: Tenant Improvement involving 135 Fire Sprinkler Heads. <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />A/C — Air Handling Units <br />Gas Piping <br />Backflow Preventer (Inside Bldg) <br />Shower, Tub, or Combo <br />Boiler <br />Gas Range <br />Clothes Washer <br />Sink -Commercial (3-comp,prep, floor) <br />Clothes Dryer <br />Heat Pump&Ductless <br />Dishwasher <br />Sink -Residential (kitchen, bath, bar) <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />Sink -Utility, laundry, mop <br />Exhaust Fans (Residential) <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type II) <br />Water Heater <br />Interceptor -Grease <br />Waste/Water Piping Repair <br />Exhaust Hood (Residential) <br />,- "' . <br />Wood Stove <br />Interceptor-Sand/Oil <br />Water Service (behind meter) <br />Forced Air Systems <br />Other: <br />ZY <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplace/Insert/Log <br />Roof Drains <br />Water Heater <br />SPRINKLER/ SUO RESSION <br />1fSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />1135 <br />jNoi of Heads <br />Chemical Suppression System <br />I <br />INO. of Heads <br />AUKNUWLEDGEMENT I have revi ed this applicagon and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br />current federal, state, and local law. le granting qfa permit only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the <br />Building Official before being authorize upy circumstance. I am the owner, or I am authorized by the owner of this property to perform the work for which application is made, <br />and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Robert Flx Ot/21/2021 <br />2021.01.21 14 48:05-08'00' <br />Owner/Authorized Agent Signature Date <br />City of Everett Official Use Only <br />PERMSXeac) r - <br />(Revised 1011012018) 1 <br />