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PERMIT APPLICATION <br /> BUILDING!MECHANICAL!PLUMBING!SIGN/SPRINKLER!DEMOLITION <br /> /111j-:‘ CITY OF EVERETT PERMIT SERVICES <br /> 3200 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:906 SE Everett Mall Way PROPERTY TAX#: 28051800308500 <br /> LEGAL for new construction: Short Plat/subdivision see legal sheet A-1 dwgs Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: PFLUEGER-EVERETT HOLDINGS LLC TENANT NAME(If Commercial): New Cingular Wireless PCS, LLC <br /> OWNER MAILING ADDRESS: STREET 601 Union Street#5300 <br /> CITY Seattle STATE WA ZIP 98101 <br /> OWNER PHONE: (OWNER EMAIL: <br /> CONTRACTOR NAME: General Dynamics Info Tech <br /> CONTRACTOR ADDRESS: STREET 19240 Des Moines Memorial Drive South Suite 300 <br /> CITY SeaTac STATE WA ZIP 98148 <br /> CONTRACTOR PHONE: 425-201-4830 CONTRACTOR EMAIL:jay.kim@gdit.com <br /> CONTRACTOR LICENSE#(REQUIRED): GENERD1927CG CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):054962 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 4n OTHER(Please Specify) Authorized Agent <br /> CONTACT NAME: CONTACT PHONE: 0:206-523-1941 /M:425.351.3392 <br /> Christine Contreras, on behalf of AT&T CONTACT EMAIL:ccontreras©rykaconsulting.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Unmanned Wreless Communications Facility Contract Price of Work:$15,000.00 <br /> Proposed Use of Building:Unmanned Wreless Communications Facility Heat Source: ❑Gas ❑Electric ❑Other N/A <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Mufti-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition I✓7Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Replace three existing RRH units on an existing rooftop wireless facility. No increase in height or ground <br /> disturbance. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): BI 710-054 <br /> MECHANICAL PERMIT APPLICATIONN/A I PLUMBING PERMIT APPLICATION <br /> Type of Project: New_ Addn Alteration _Rep r 1 Type of Project: _New _Addn _Alteration _Repair IN/A l <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures F— <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater____ Bathtub Urinal _ <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove _ Kitchen Sink&Disposal Grease Trap <br /> Gas Range 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'-/SUPPRESSIOt1&Y5TEM <br /> lNumber of Heads N/A <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 before 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 the State Contractors Law 18.27 RC W and 296.200A WAC. <br /> CityofEverett Official Use Only <br /> G^ 41/0/ <br /> C s ✓,fes. ��trz+ /� / PER IT#_ l V(0 10u3 <br /> Owner/Ao1l itgent Signature ` Da / (Revis /2�/2016) <br />