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PERMIT APPLICATIC <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: 2930 MAPLE STREET, EVERETT, WA 98201 <br />PROPERTY TAX #: 00439069505800 <br />LEGAL for new construction: Short Plat/subdivision S e e 5A G' No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: KAISER PERMANENTE (ATTN:RANDY OLSEN) TENANT BUSINESS NAME (Commercial): KAISER PERMANENTE <br />OWNER MAILING ADDRESS: STREET 1200 SW 27TH STREET <br />CITY RENTON STATE WA Zip 98057 <br />OWNER PHONE: 206-658-5279 <br />OWNER EMAIL: Randy.E.Olsen@kp.org <br />CONTRACTOR NAME: MORTENSON CONSTRUCTION (ATTN: HOLLY SHOUBRIDGE) <br />CONTRACTOR ADDRESS: STREET 10230 NE POINTS DRIVE, SUITE 300 <br />CITY KIRKLAND STATE WA ZIP 98033 <br />CONTRACTOR PHONE: 425-497-7092 <br />CONTRACTOR EMAIL: holly.shoubridge@mortenson.com <br />CONTRACTOR LICENSE #(REQUIRED): CC MAMORC'1901\16 <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 021465 <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR 0 OTHER (Please Specify) ARCHITECT <br />CONTACT NAME: <br />DOUGLAS MCNUTT <br />CONTACT PHONE: 206-957-1906 <br />CONTACT EMAIL: douglas.mcnutt@salus.archi <br />BUILDING INFORMATION <br />Existing Use of Building: MEDICAL OFFICE BUILDING <br />Contract Price of Work: $ 11,000 <br />Proposed Use of Building: MEDICAL OFFICE BUILDING <br />Heat Source: E]Gas ❑Electric ❑Other <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑✓ Commercial ❑Accessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑✓ T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: Adding a cross -corridor to 2nd floor to separate the Behavioral Health form Admin area. The new door <br />will create a dead-end corridor longer than 50 feet on one side. Since the door will be locked, a delayed egress system will be <br />installed to allow existing into the adjacent corridor. This door will have panic hardware. <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 />Backflow Preventer (Inside Bldg) <br />Shower, Tub, or Combo <br />Boiler <br />Gas Range <br />Clothes Washer <br />Sink -Commercial (3-comp,prep,floor) <br />Clothes Dryer <br />Heat Pump&Ductless <br />Dishwasher <br />Sink -Residential (kitchen, bath, bar) <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />Sink -Utility, laundry, mop <br />Exhaust Fans (Residential) <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type 1) <br />Hose 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 />Water Service (behind meter) <br />Forced Air Systems <br />I <br />Other: <br />Medical Gas <br />1 Water Valves or Fixtures <br />Gas Fireplace/Insert/Log <br />I <br />IRoof <br />Drains <br />Water Heater <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />No. of Heads <br />Chemical Suppression System <br />No. of Heads <br />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 <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. I am the owner, or l am authorized by the owner of this property to perform the work for which application is made, <br />and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />& Lpa:14- r° 2M PERMIT A)I'DH 2-1 <br />Owner/Authorized Agent Signature r Date (Revised 1011012018) J <br />Z <br />