1717 13TH ST MEDICAL CENTER 2025-08-20

mop Bl: DING PERMIT APPLICAT'f1N D ECEOVEDEVERETT SUBMITTAL INSTRUCTIONS:See CITY OF EVERETT PERMIT SERVICES applicable submittal checklist for submittal requirements d num (of IgcUiel uired iew, WASHINGTON then drop off completed application plus all required submittal documents to 321� dar trelest n FI I takeox. CONTACT INFORMATION: (P)425-257-8810 I (E)PermitServices@everettwa.gov I (W)veretr tv,/prmits rr (Blue or Black Ink Only Please) PROJECT SITE INFORMATION POfmlt sOfVIC06 PROJECT SITE ADDRESS: STREET 1717 13th St PARCEL#: 00409423000100 CITY Everett STATE WA ZIP 98201 SUITE/UNIT#: FLOOR#: 2 ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):Providence Regional Medical Center LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Providence OWNER MAILING ADDRESS: STREET 1321 Colby Ave CITY Everett STATE WA ZIP 98201 OWNER PHONE:(425)891-4833 OWNER EMAIL: Christopher.LaRue@providence.org CONTRACTOR COMPANY NAME:DPR Contruction WA STATE CONTRACTOR LICENSE#(REQUIRED):DPRCOCG833BP CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 67180 CONTRACTOR ADDRESS: STREET 1000 1st Ave South, Suite 400 CITY Seattle STATE WA ZIP 98134 CONTRACTOR PHONE:650-863-6280 CONTRACTOR EMAIL:JeffAs@dpr.com PRIMARY CONTACT: D OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:(425)891-4833 Chris La Rue CONTACT EMAIL:Christopher.LaRue@providence.org BUILDING INFORMATION VALUATION OF WORK: $490,400 ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING:Cancer Treatment Center PROPOSED USE OF BUILDING:Cancer Treatment Center HEAT SOURCE: LiGas ❑Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑✓T.I. ❑Change of Use ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: REPLACEMENT OF EXISTING PET CT EQUIPMENT WITH NEW EQUIPMENT, INCLUDING GANTRY& ASSOCIATED ELECTRICAL& PLUMBING WORK. EXISTING LASERS TO BE RELOCATED; OTHER BUILT-IN EQUIPMENT TO REMAIN. MECHANICAL(HVAC) LIMITED TO BALANCING; STRUCTURAL WORK LIMITED TO EQUIPMENT ANCHORS. NO CHANGE TO OCCUPANCY OR EXIT ACCESS NO EXTERIOR WORK. PET CT ROOM& INJECTION ROOMS AREAS MODIFIED- APPROX 740 SQ FT 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 Digitally signed by Christopher J La Rue ///�� h } rJ O=Prov enc Christopher.LaRue Construction PERMIT PERMIT# �,2 / ' �^ ^ t L Christopher La Rue ManagerdCNeChrsdoPnOj DeRsge Construction /vly1 I 71 Date:2024,07.03 16''51,27-07'00' Owner/Authorized Agent Signature Date (Revised 4/21/2022)