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PERMIT APPLICATION <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION - <br />PROJECT SITE ADDRESS: 709 80th St. SW Everett WA 98203 <br />PROPERTY T #: 00412300000700 <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legs es <br />CONTACT INFORMATION <br />OWNER NAME:Jeanne Will Verizon is the owner of the tower facilit ENANT NAME (If Commercial): Verizon <br />OWNER MAILING ADDRESS: STREET <br />CITY evue-STATE ZIP <br />OWNER PHONE: Will: Unknown; Verizon: 425-603-2824 OWNER EMAIL:Will (Unknown); Verizon: shirle .van en-Overizonwireless.co <br />CONTRACTOR NAME: TBD <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: NTRACTOR EMAIL: A 62L 2, l)� <br />CONTRACTOR LICENSE #(REQU ED): <br />G <br />CITY OF EVERETT BUSINESS LICENSE #(REQUI D): <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR OTHER (Please Specify) Verizon Authorized Representative <br />CONTACT NAME: John Eder, J4 Site Solutions, Inc. as <br />Authorized Representative of Verizon <br />CONTACT PHONE: 253-278-2902 <br />CONTACT EMAIL: john(&,j4sitesolutions.com <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Wireless Telecommunication Facility <br />Contract Price of WOII $ 15,000 <br />Proposed Use of Building: No change Heat Source: ❑Ga ❑ElecWOther <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi -Family-# of Units: LNCommercial ❑Industrial <br />Type of Project: ❑New ®Addition ❑Remodel ❑Repair ❑T.I. ❑Sin []Sprinkler ❑Demolition ❑Chan a of Use <br />DESCRIPTION OF WORK: At the top of the existing 155' tower, replace all (12) panel antennas, replace (3) existing remote radio heads, add <br />(3) new remote radio heads, <br />ASSOCIATED BUILDING PERMIT # if applicable): N/A <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New Addn _Alteration Repair <br />Type of Project: _New _Addn _Alteration _Repair <br />Fixtures <br />List of Fixtures <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />A/C — Air Handling Units <br />Heat Pump <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />Kitchen Sink & Disposal <br />I <br />Grease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />Other: <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />Water Heater <br />Other: <br />Exhaust Fan <br />Sink (Service/Bar/Mop/etc.) <br />Other: <br />SPRINKLER <br />/ SUPPRESSION <br />SYSTEM <br />Chemicai or Water I <br />I No. of Heads <br />ACKNOWLEDGEMENT: / 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 before being authorized under any circumstance. I am the owner, or 1 am authorized by the owner of this property to perform the work for which application is made, <br />and l co Y the State Contractors Law 1 .27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />L Z— - PE # <br />John J4 Site Solutions, Inc as Authorized Representative of Verizon lc)l <br />Own r/Authorized Agent Signature Date (Revised 9/23/2016) ::P11D <br />