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� r <br />Facility <br />Facility Name: <br />Site Address: <br />Data Certificate: <br />Providence Hospice and Home Care of Snohoinish Co Licensee UBI#: 313007977 <br />1321 Colby Ave, 8rh Flor <br />�verett, WA 98201 <br />�stimated Date of Occupancy: <br />Critical Access Facility: ❑ Yes ❑ No <br />Occupancy I-2 Construction Applicable Code: 2000 NFPA 101 <br />Group: Type: 2012 IBC <br />� <br />W Number of Current: 0 Added: l6 Removed: TotaL• 16 <br />� Qeds: <br />��,, nutomatic [�'ire Sprinl:ler System: � Ycs ❑ No Type 13 <br />F� <br />� Automatic Fire Alarm System: � Yes ❑ No <br />� Coinpartine�Itation req'd: �Yes ❑No S���oke Control Systein Provided: ❑ Yes �No <br />w <br />aSpecial Dclayed Egress Control: ❑ Yes �No Location: <br />d <br />Certificatc ofNeed Required: ❑ Ycs �No CON Approval Granted: ❑ Yes ❑No <br />CON Number : <br />Nu�nber of units: Private occLipancy: <br />�,.�� Based on size of rooms used for sleeping Residents <br />aZ <br />O Based on size of common T�ooms Residents <br />� <br />H� Maxi�nun� allowable licensable beds: <br />A� Qualities for Assisted Living l�unding Program <br />� <br />� U <br />� � <br />a � <br />� <br />W <br />H <br />O <br />Z <br />Yes <br />Two person occupancy: <br />No Number of qualifying units: <br />/Add a 16 bed Hospice Care Cente�- on the 8th floor of the old Providence hospital A-wing iil Everett, WA <br />The data above is based on the infoi•mation presented to CRS. Any change in the facility or facility program that <br />causes the above iuformation to be incorrect is subject to review by CRS. Approval for construction is not <br />approval for licensure. A copy of the facility data cerYificate will be sent to the licensing agency. <br />Page 2 of 1 1 Plan Review Comments for Pt�oject # 60542870 � �� <br />_ ; � <br />