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� � <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar SI., Everett. WA 98201 425-257-8870 F�X 425-257-8857 vnw�.everettwa.org <br /> G- II-IS <br /> SITEADDRESS: �ROPERTrTNtp (J���jgj?��C7OO000 PERMITe <br /> 1321 Colhy aec S— � <br /> LEGAL lor new construchon Sh;rt PlaVsubtlrv,ion_ Lot No. latlacn copy ot lonq legal Oescnp;�on) <br /> owNErt provtdence Heahh Services Phone�E�ma�l <br /> namess 4�1 l.ind Ave S�c x901( caY�sia��mP Renton \Va 98057 <br /> APPUCANT:_Owner �`�7wnersAgrnt _Con'racto� _Gontractc%st.gent _Tenant���+�o���aea�e-urunu���,c.rmoc.-�,wn..�. �^e,c+•�; <br /> CONTRACTOR �'lastrc \Vireless Solutions Slate�ic # ('(�\�r�S�rF�Sg%6hiV Cdy[3us L�t. k <br /> I53q5 I�arificld Kanch Ad Chino liills CA 91709 vno�ei�ma�i <br /> nad,es <br /> TENANT BUSINE55 NAME CONTACT FOR PERMIT <br /> :1'fST l�anicl linum <br /> PhonelE�ma�A )�(� FF� -Hlli{ <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK StiO� <br /> E.�sLng Use ol �wldmg_ HGAT SOURCE <br /> Prc,osed Use of�uJdmg Gas EicUr�c Oiher <br /> 9��.id�nn;ype _Single Family _Duplex_To�vnhouse _IduYi-Family \ Co�nmernal <br /> 1 e r,1 ro ecl� IJew AddiUon Remodel Re a�r � T I. Smn Sprmkler Demoldion Chan e of Use <br /> OESC RIPTION OF WORK iaCtl�honar spare F�ov�aetl on rn=bacwJ �TBT proposal to remove an�1 reptace 3 antennas and 3 RRH amphfiers <br /> ��„a i 1 0t3U rach m exisbng penlhouse eqwpment room Height r:�ll not change <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type al Pio�uct: _New_Addn _Alleration_Repair Type ol ProjecC _New_Addn _Alieralion_Repair <br /> ShowNumGrr p o/fixfures ShowNumber(kJollufures <br /> ��C-an handl�n units To�;el <br /> Forr.ed a�r s s�ems Balhtub <br /> Gas i in I.avator wash basin <br /> \Natcr he3ler Shrnrer <br /> Gas Lre �ace Kitcl�en sink 8 dis osal <br /> Gas ran e Uishwasher <br /> Clmhes dr er Clolhcs washer <br /> Ran e hooA Water healer <br /> [xhaust lan Sink scrv�r.e�barlmo letc 1 <br /> Heat pump [3ackllov+ veventer msiAe bldn <br /> Unit healer �����'��� <br /> �oiler Dnnkino Founlam <br /> Re(n eralion F�oor drain <br /> Woodstove Grease Ira <br /> Ductinn Rool tliains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM O�her <br /> Num6er of Heads Olher <br /> 1�prtby cen!y inaf I have�eaC and e.am�nee mrs rppLwt�on a.�C�now IAe same lo Ce ime and conecl All Orov�s�ons ol laws and orC�nonas gavermng�hn lype ol�wiA w�A be ccmp�. <br /> v.+in wheiner spn.c�L=�J pemm or noi 7 ne a�anung ol a DermA does no1 piewme to qwe auinonry Io violate oi wncel Ine O�a�sron o1 anY olner sta�e or lowl law�egulalmo canslmcucn <br /> T�ai i am au'.no��zea by me awnee ol l�is propeny la pe�orm Ihe woik lar wh:ch appbaiuon rs matle anE 1 comply�vA�Ihe$izle Conbacmrs Law IB 77 RC W anO 295 300A WAC. � <br /> � � <br /> Owner/AuthorizeA Pgent Signaturc Dzte (!%^���_�ed Ji'0�5) <br />