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40" I ASI <br /> BUILDING /MECHANICAL PERMIT/PLUMBINGAPPLIC/SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> T3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:6320 Evergreen Way PROPERTY TAX#:00393000000700 <br /> LEGAL for new construction: Short Plat/subdivision(see attached drawings) Lot No.37 (attach copy of long legal description) <br /> CONTACT,INFORMATION <br /> OWNER NAME:Grayson, Bovey, & Williams TENANT NAME(If Commercial): Multiple <br /> OWNER MAILING ADDRESS: STREET6320 Evergreen Way, STE A <br /> CITY Everett STATE WA zIP 98203 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME:TBD <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: t <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIR1 D): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR @ OTHER(Please Specify) •• - ., ', ' ' ••• - ' •• i <br /> CONTACT NAME: CONTACT PHONE:805-807-9942 <br /> Travis Griffith CONTACT EMAIL:TGriffith@Ode' .co <br /> n BUILDING PERMIT APPLICATION <br /> Existing Use of Building:Office/Commercial Contract Price of Work:$60,000 <br /> Proposed Use of Building:Wireless Facility Heat Source: ❑Gas ❑Electri ❑Other N/A <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: @Commercial ❑Industrial <br /> Type of Project: ❑New @Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Installation of equipment enclosures with antennas and ancillary <br /> equipment on an existing rooftop. Construction of CMU enclosure and <br /> installation of equipment cabinets on ground. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION` PLUMBING PERMIT APPLICATION <br /> Type of Project: New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> Fixtures List of Fixtures Ffxt res List of Fixtures Fixtures List of Fixtures Fiero es List of Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Syste s Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basi• Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range J Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups` Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I 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 befo 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, <br /> and I comply with he tate Contractors Law 18.27 RCW and 296.200A WAC. <br /> % City of Everett Official Use Only <br /> 2( _1 41• - i PERMIT <br /> i 7G� I�lOZ"X31 <br /> .wir 3 rIkuthori4ed Agent Signature Date (Revised 9/23/2016) <br />