2929 PINE ST KAISER PERMANENTE 2023-12-27

PLUMBING PERMIT APPLICATION EVERETT SUBMITTAL INSTRUCTIONS: OF EVERETT PERMIT SERVICES S: Drop off hard copy completed paper application to 3200 Cedar Street 2nd Floor Intake Drop Box. WASHINGTON CONTACT INFORMATION: (P)425.257.8810 1 (E)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 2929 Pine Street PARCEL#: Federal Tax ID-91-0511770 Parcel Number-00439069505800 CITY Everett STATE WA ZIP 98201 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential):Kaiser Permanente CONTACT INFORMATION OWNER NAME:Kaiser Permanente/Gretchen Benzin OWNER MAILING ADDRESS: STREET 1200 SW 27th Street CIT, Renton STATE WA zlp 98057 OWNER PHONE:206-630-6726 OWNER EMAIL:gretchen.l.benzin@kp.org CONTRACTOR COMPANY NAME:McKinstry CO LLC WA STATE CONTRACTOR LICENSE#(REQUIRED):MCKINC1942DN CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 049226 CONTRACTOR ADDRESS: STREET 5005 3rd Ave S CITY Seattle STATE WA ZIP 98134 CONTRACTOR PHONE:206.762.3311 CONTRACTOR EMAIL:permits@mckinstry.com PRIMARY CONTACT: ❑OWNER El CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206.790.1091 Robert Fix CONTACT EMAIL:permits@mckinstry.com PLUMBING PERMIT INFORMATION VALUATION OF WORK: $$1,000 ASSOCIATED PERMIT#(if applicable):P2202-009 (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: OCommercial ❑Accessory Structure DESCRIPTION OF WORK: New backflow for temp Site water PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) Fixture Fixture Count List of Fixtures Count List of Fixtures (Qty) (Qty) Backflow Prevention Device(Inside Building)-select devices below: Shower,Tub,or Combo Fire Service: ❑DCDA, Domestic Service: ❑RPBA❑DCVA Commercial Sink(3-compartment,prep,floor) Clothes Washer Residential Sink(kitchen,bath,bar) Dishwasher Utility Sink(laundry,mop) Drinking Fountain Toilet Floor Drain Urinal Hose Bibb Waste/Water Pipe Repair Ice Maker Water Service Line(Behind meter,private side) Grease Interceptor Water Valves/Fixtures Sand/Oil Interceptor Water Heater-Electric Medical Gas Water Heater-Gas Roof Drains Other(List Type): Sewage Ejector Pump/Sump Pump 1 1 Other(List Type): ACKNOWLEDGEMENT:1 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.1 am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# David Erickson 05/04/2022 Owner/Authorized Agent Signature a..o Date (Revised 2/8/2021)