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10 0 <br />PERMIT APPLICATION <br />EVERETT <br />WASHINGTON <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 l (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />Bluo or Black Ink Only Please PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS:1010 SE Everett Mall Way, Suite 104 <br />PROPERTY TAX #: �k vco kli(2 <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: Everett Mall Office Building, LLC TENANT BUSINESS NAME (Commercial): Northwest Kidney Centers <br />OWNER MAILING ADDRESS: STREET 1429 Ave. D, #521 <br />CITY Snohomish STATE WA zip 98290 <br />OWNER PHONE: (425)330-6882 <br />OWNER EMAIL: rkirtley@kirtleysite.com <br />CONTRACTOR NAME: Brendon Warme, Aldrich + Associates <br />CONTRACTOR ADDRESS: STREET810 240th Street SE <br />CITY Bothell STATE W4 ZIP 98021 <br />CONTRACTOR PHONE: (425) 486-3071 <br />CONTRACTOR EMAIL: BWARME@ALDRICH-ASSOC.COM <br />CONTRACTOR LICENSE #(REQUIRED): GC ALD P,( * 202 R 0 <br />ICITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 43 7 <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑r OTHER (Please Specify) Architect <br />CONTACT NAME: <br />Andy Drissell, Mahlum Architects <br />CONTACT PHONE: (206) 816-1058 <br />ICONTACT EMAIL:ADRISS HLUM. <br />BUILDING INFORM ON <br />Existing Use of Building: Commercial (B Occupancy) <br />Contract rice of wok $1 166,951 <br />Proposed Use of Building: Dialysis Clinic (B Occupancy) <br />Heat Sol rce: Q6as ElElectric ❑Other <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑✓ Commercial EXccessory Structure <br />Type of Project: ❑New ❑Addition []Remodel ❑Repair ❑✓T.I. ❑Sign ❑ prinkler ❑Demolition AhangeofUse <br />story office building. <br />DESCRIPTION OF WORK: Tenant Improvement build -out of a dialysis clinic on�(,new <br />Area of improvement include -A" feet. Exterior scope is limited towithin existing storefront <br />t�ei <br />system, a new patient drop-off zone, and some new sidewalk connections at the designated building entries. <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 Pi ' g <br />Backflow Preventer (Inside Bldg) <br />Shower, Tub, or Com <br />Boiler <br />Ga ange <br />Clothes Washer <br />Sink-Commerc'-comp,prep,floor) <br />Clothes Dryer <br />eat Pump&Ductless <br />Dishwasher <br />Sink-R ' ntial (kitchen, bath, bar) <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />-Utility, laundry, mop <br />Exhaust Fans (Residential) <br />Commercial Ventilatio <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type I) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type lIV <br />Water Heater <br />Interceptor -Grease <br />Waste/Water Piping Repair <br />Exhaust Hood (Res' ntial) <br />Wood Stove <br />Interceptor-Sand/Oil <br />Water Service (behind meter) <br />Forced Air Syst s <br />Other: <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Firepla nsert/Log <br />I <br />Roof Drains <br />Water Heater <br />SPRIN R`/ SUPPRESSION <br />SYSTEM'' <br />Se -a jector or Sump Pump <br />Other: <br />Water SuppresW System <br />I <br />INo. of Heads <br />Chemical SuOression System <br />No. of Heads <br />ACKNOWLEDGEMENT: I have reviewed this application and confirm the informatioi contained herein is true and correct. Work done pursuant to this permit must comply with <br />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 <br />Building Official before being authorized under any circumstance. 1 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 S e Contractors Law 111.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERRALT #1 //'��1�/ (/M�\) <br />Austin Ross Digitallys9.12. 3y 6:21: -08' \ — ` — ) / l J <br />Daib,fly ig 2 by .,b, -08'W 12/13/19 ` v f��-'� <br />Owner/Authorized Agent Signature Date (Revised 1011012018) <br />3k <br />