1321 COLBY AVE BASE FILE 2022-11-16

IIIIIIIIII • PERMIT APPLICATION • BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHtNGTON (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: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 c,n. 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 �/ 1 CONTRACTOR LICENSE#(REQUIRED):MAMORC*190N6 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ra y vl `A. PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR 0 OTHER(Please Specify) Architect CONTACT NAME: CONTACT PHONE:509-991-9653 Jill Kurtz CONTACT EMAIL:jkurtz@nacarchitecture.com BUILDING INFORMATION Existing Use of Building:Hospital Contract Price of Work: $750,000 Proposed Use of Building:Hospital Heat Source: OGas ❑Electric ❑Other BUILDING USE: ESFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure Type of Project: New EAddition ❑❑✓Remodel ❑Repair LTA. ❑Sign LSprinkler EDemolition ❑Change of Use DESCRIPTION OF WORK: Renovation of existing helipad to be an enclosed behavioral health roof top deck ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures NC—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 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 r___.ERma#2 �/ II -- , 3-16-2021 L ?— ct, Owner/Aut14ed Agent Signatu Date (Revised 10/10/2018) i/-,