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, . � <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBINGISIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8870— FAX 425-257-8857—wewv.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADD�2ESS: PROPERiYTAXM PERMITk ^ O � <br /> Se28 G enwood Ave 'L O�OO�.OIZW <br /> LEGAL for new construclion: Short PlaVsubdivision Lot No._ (attach copy of lonq legal descnplion) <br /> Snohomish PUD Nancy Middleton,925-783-5606 <br /> OWNER PhonelE-mail <br /> Address <br /> p0 Box 1107 GrylSlate.�Lp Everett, WA 98206-1107 <br /> CONTRACTOR TBD �v issuance L&I Lic.# <br /> P.ddress PhenelEmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> AT&T MobiliCy &ecky Todd, 206-310-1793, bto�d3ptswa.com <br /> PhonelE-mail <br /> BUILDINGPERMITAPPLICATION CONTRACTPRICeoFwoRK Sis,oao <br /> Existing Useof Building N/A - existing monopole HEAT SOURCE: <br /> ProposedUseofBuilding mod to existing monopole - telecom Gas_ Electric_ Other <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family x Commercial <br /> Type of project: _New _Addition _.Remodel _Repair x T.I._Sign_Sprinkler_Demolilion_Changa ot Use <br /> Deseriplion of Work(addilional spacopm•ndedon the back): <br /> Replace existing three (3) panel antennas with three (3) new models. <br /> Have you slarted working without a permit? _YES x NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLlCATION <br /> Typa of ProJect: _Now_Addn _Altoration_Repatr Typn of ProJect: _Nnw_Addn _Altnralion_Repair <br /> Show Number(#)a!�xfuras Show Numbar�p�o/fixtures <br /> A/C—air handling unils Toilet <br /> Forced air s stems Bathlub <br /> Gas piping lavalory(wash basin) <br /> Water healer Shower <br /> Gas fueplace Kitchen sink 8 disposa� <br /> Gasranqe Dishwasher <br /> Clothes dryer Clothes washer <br />� Ranqe hood Water heater <br /> Exhausl fan Sink(servicelbar/moplelc.) <br /> Heat pump Backilmv prevenler <br /> Unil healer Urinal <br /> Boiler Drinking Fountain <br /> Refri eration Fioordrain <br /> Woodstove Grease trap <br /> Ductin Roof drains <br /> � Other � Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> NumberofHeads Other. <br /> I hereby certify Ihal I have read and eaamined Ihis appliwtion and know the same l0 6e true and correc4 All pmvisions of la�+s and ordinances goveming <br /> this type of�wrk�NII be complied�+ilh wfiether specified herein or noL Tho 9rantinq of a permit does not presume to give authonry lo violala ar cancel <br /> the provision o(any olher slale or lowl law regulaling conslruction or the peAormance of construclion.That I am authorized by the o�wer of this propeny <br /> lo pedortn the�wrk for which application is made and I comply�Hth lhe Slala Contractors Law 18 27 RC1N and 290.200 WAC <br /> `�n .!�—�� �l �tsJr� <br /> Owne I uthori d A nt SlgnaNre Date (Revised712017) <br /> I�Z <br />