916 PACIFIC AVE BASE FILE 2021-12-10

MIMI PERMIT APPLICATIOkik 12 BUILDIN ECHANICAL / PLUMBING / SIGN , PRINKLER / DEMOLITION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS:916 Pacific Avenue, Everett, WA 98201 PROPERTY TAX#:29053000200100 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Providence Everett Regional Medical Center TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET 1321 Colby Avenue ciTY Everett STATE WA ZIP 98201 OWNER PHONE: Jim Grafton/425.261.4563 OWNER EMAIL:James.Grafton@providence.org CONTRACTOR NAMJBD CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: DOWNER ❑ CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425.261.4563 Jim Grafton CONTACT EMAIL:James.Grafton@providence.org BUILDING INFORMATION Existing Use of Building:1-2 Hospital Contract Price of Work: $ Dt 05 Proposed Use of Building:Same Heat Source: ❑Gas ❑Electric ❑Other BUILDING USE: ESFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure Type of Project: CNew ❑Addition ❑✓Remodel ❑Repair ❑T.I. ❑Sign ESprinkler ❑Demolition ❑Change of Use DESCRIPTION OOtF� c WORK: An existing 1J57 SF storage room is to be renovated to be an in-patient pharmacy space Net.) c1 t I ✓A-S r I-,L'"✓ `�i l !c, /Z c Lti . e✓ret ys 1 11'1/L ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture List of Fixtures Fixture Count Count List of Fixtures Count List of Fixtures List of Fixtures Count A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler Gas Range Clothes Washer 1 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 Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) 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: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log 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.-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. City of Everett Official Use Only PERMIT# .. 8Z \�o „ , O* Owner/Authorized Agent Signature Date (Revised 10/10/2018) I