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01 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 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 1010 SE Everett Mall Way, Suite 100,102,104, Everett, WA 98208 <br />PROPERTY TAX #: 2742973 (Suite 100) / 28051800306600 (Building) <br />LEGAL for new construction: Short Plat/subdivision <br />Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: Randy Thompson <br />TENANT BUSINESS NAME (Commercial): <br />Northwest Kidney Centers <br />OWNER MAILING ADDRESS: STREET 1903 S 128th St <br />c,Ty ' SeaTac <br />STATE WA <br />zIP 98168 <br />OWNER PHONE: (206) 292-2771 <br />OWNER EMAIL: randy.thompson@nwkidney.org <br />CONTRACTOR NAME: Stirrett-Johnsen, Inc. <br />CONTRACTOR ADDRESS: STREET5555 Westgate Rd NW <br />CITY Silverdale <br />STATE WA <br />ZIP 98383 <br />CONTRACTOR PHONE: (360) 692-6128 <br />CONTRACTOR EMAIL: julie.lopez@sjimech.com <br />CONTRACTOR LICENSE #(REQUIRED): STIRRJ'281 B6 <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIR : ALL L &I [ t <br />PRIMARY CONTACT: ❑ OWNER El CONTRACTOR ❑ OTHER (Please Specify) <br />-114 <br />CONTACT NAME: <br />Julie Lopez <br />CONTACT PHONE: (360) 692-6128 <br />CONTACT EMAIL: julie.lopez@sjimech.com <br />BUILDING INFORMATION <br />Existing Use of Building: Commercial Office Space <br />Contract Price of Work: $ 460,000 <br />Proposed Use of Building: Kidney Dialysis Clinic <br />Heat Source: []Gas (]Electric ❑Other <br />BUILDING USE ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family- # Units: ❑✓ Commercial <br />❑Accessory Structure <br />Type of Project: ❑New []Addition ❑Remodel ❑Repair <br />✓❑T.I. ❑Sin ❑Sprinkler ❑Demolition <br />❑Change of Use <br />DESCRIPTION of WORK: Plumbing and Medical Gas Piping to support a new dialysis clinic. There will be 11 patients stations, 2 <br />home training suites and associated plumbing fixtures. <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 />5 <br />Backflow Preventer (Inside Bldg) <br />1 <br />Shower, Tub, or Combo <br />Boiler <br />Gas Range <br />Clothes Washer <br />Sink -Commercial (3-com p, prep, floor) <br />Clothes Dryer <br />Heat Pump&Ductless <br />Dishwasher <br />18 <br />Sink -Residential (kitchen, bath, bar) <br />Duct System (Remodel) <br />Refrigeration <br />2 <br />Drinking Fountain <br />2 <br />Sink -Utility, laundry, mop <br />Exhaust Fans (Residential) <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />9 <br />Floor Drain <br />4 <br />Toilet <br />Exhaust Hood (Type 1) <br />1 <br />lHose Bibb <br />Urinal <br />Exhaust Hood (Type 11) <br />Water Heater <br />Interceptor -Grease <br />Waste/Water Piping Repair <br />Exhaust Hood (Residential) <br />Wood Stove <br />Interceptor-Sand/Oil <br />1 <br />Water Service (behind meter) <br />Forced Air Systems <br />Other: <br />1 <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplace/insert/Log <br />I <br />Roof Drains <br />1 <br />Water Heater <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />1 <br />21 <br />Other: Dialysis Drain Boxes <br />Water Suppression System <br />I No. of Heads <br />1 2 <br />'remise Backflow PreventE <br />1 <br />Water Submeter <br />Chemical Suppression System <br />jNo. of Heads <br />1 1 <br />Exterior Hot Box <br />13 <br />Medical Oxycien Outlets <br />ACKNOWLEDGEMENT: / have reviewed this application 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. 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. l am the owner, or / am authorized by the owner of this property to perform the work for which application is made, <br />and / comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />M <br />uthorized Agent Signature Date <br />City of Everett Official Use Only <br />PERMIT ,,, , 6 In <br />r <br />(Revised 1011012018) (��J, <br />