20150812164447.pdfLetter of Transmittal
August 9, 2015
Address Plans To (internal use only);
Swedish Edmonds
Attn: Facility Administrator
21601 76th Ave W
Edmonds, WA 98026-7507
RECEIVED
AUG 112015
lawsaffim
Washington State Department of
Construction Review Services
111 Israel Rd. SE
Tumwater, WA 98501
PO Box 47852
Olympia, Washington 98504-7852
www.doh.wa.gov/crs
tel. 360-236-2944
fax. 360-236-2321
Project Info:
CRS# 60575684 Project 21601 76th Ave W
Swedish Edmonds location: Edmonds, WA 98026-7507
Chapter 246-320 WAC Hospitals
Replace Two Air Handler Units Local Permit #:
Key People:
Assigned DOH Kevin A. Scarlett, RA, ASHRAE HFDP
Reviewer: kevin.scarlett@doh.wa.gov
Facility
Swedish Edmonds
Facility Contact:
Swedish Edmonds
Administrator:
Rex Kerby
Architect / Engineer: Salus Architecture
Camilla Yamada
®
21601 76th Ave W
21601 76th Ave W
Consultant: N/A
Edmonds, WA 98026-7507
Edmonds, WA 98026-7507
19
(206) 612-9072 x.
Contact: N/A
(206) 386-6317 x.
rex.kerby@swedish.org
camilla.yamada@providence.org
Architect /
Salus Architecture
Local AHJ:
City of Edmonds
Engineer:
Douglas McNutt
Leif Bjorback
1402 Third Ave, Ste 200
121 5th Ave N.
Seattle, WA 98101
Edmonds, WA 98020-3145
(206) 957-1906 x.
(425) 771-0220 x.
douglas.mcnutt@salus.archi
bjorback@ci.edmonds.wa.us
Consultant:
Salus Architecture
Consultant:
N/A
David Frum
1402 Third Ave, Ste 200
Seattle, WA 98101
(206) 838-1702 x.
X.
david.frum@salus. archi
Contact:
N/A
Contact:
N/A
X.
Copies To:
®
Local AHJ: City of Edmonds
®
Architect / Engineer: Salus Architecture
®
Consultant: Salus Architecture
❑
Consultant: N/A
F-1❑
Contact: N/A
19
❑
Contact: N/A
X.
DOH Child Birth Center Licensing
DOH Office of Investigations & Inspections
L&I Electrical Section
L&I Factory Assembled Structures
CRS File
Page I of 4 Plan Review Comments for Project #60575684
Facility Data Certificate:
Facility Name: Swedish Edmonds
Site Address: 21601 76th Ave W
Edmonds, WA 98026-7507
Estimated Date of Occupancy: 10/01/2015
Licensee UBI#: 602997735
Critical Access Facility: ❑ Yes ® No
... .
_..... _ .........
Occupancy I-2 Construction 1-A Applicable Code: 2000 NFPA 101
Group: Type: 2012 IBC
2010 FGI Guidelines
a Number of Current: N/A Added: N/A Removed: N/A Total: N/A
>� Beds:
Automatic Fire Sprinkler System ® Yes �No Type 13
HW
a Automatic Fire Alarm System: Yes ❑I No
re
Com artmentation 'd:
p q ®Yes
❑No Smoke Control System Provided: E] Yes No
aSpecial Delayed Egress Control: ❑ Yes No Location:
Certificate of Need Required: ❑ Yes No CON Approval Granted: Yes No
CON Number:
..... .... ..
Number of units: Private occupancy: Two person occupancy:
�.� Based on size of rooms used for sleeping Residents
z
O Based on size of common rooms Residents
H Maximum allowable licensable beds:
...... ...........
A Qualifies for Assisted Living Funding Program ❑Yes ONo Number of qualifying units:
There is no FA or FS work anticipated as a part of this project.
�_ ___ _ _.................... __. ._..............
The data above is based on the information presented to CRS Any change in the facility or facility program that
causes the above information to be incorrect is subject to review by CRS. Approval for construction is not
approval for licensure. A copy of the facility data certificate will be sent to the licensing agency.
Page 2 of 4 Plan Review Comments for Project # 60575684