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A two-floor expansion housing general pediatric beds and the hospital's Pediatric Intensive Care Unit (PICU). The exterior design uses patterned red brick, metal and glass to seamlessly blend in with the structure below. Located on a tight, urban site, with surrounding poured-in-place concrete buildings, the design is carefully inserted into the hospital with a series of thoughtful "interventions" composing the new tower. The addition replaces aging infrastructure and responds to an increasing demand for children's healthcare services in the South Puget Sound region. The interior design follows a maritime theme that focuses on the landmarks and life found in and around Washington's South Puget Sound.

The same poured-in-place concrete construction maintains structural integrity, but it is clad with a new exterior material palette. This theme is seen in all areas of the expansion, from patient footwalls adorned with very stylized illustrations of coastal life to a play area featuring colorful fish shapes dangling from the ceiling, an aquarium teeming with life, expansive artwork done by local artists, and photographs of sea animals living at Tacoma's Point Defiance Zoo. Paul acts as a new gateway to the hospital complex and establishes a new architectural language to inform future campus projects. Representative of stacking of simple children's blocks, the massing is informal and playful. Various sized "blocks" are wrapped in anodized aluminum and zinc metal panels, sandstone colored brick, and curtain wall glazing.

The red metal panels and sandstone-colored brick tie the design to the existing mostly brick campus through color, but offer a fresh, clean, "high-tech" material more in keeping with a modern healthcare facility. A roof garden provides a place of respite for children and their families, while also serving to minimize the building's heat gain.

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