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r . <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> 13 CO BY AVENUE IP8UE438Stl46 000 00 PE RIM 1,25 /Db 1(4. <br /> LEGAL for new construction: Short Mat/subdivision Lot No._ (attach copy o1 long legal descnpan) <br /> OWNER PROVIDENCE EVERETT MEDICAL Pnon•,E.mad <br /> Address 916 PACIFIC AVE GtyfState/Zip EVERETT, WA 98206 <br /> CONTRACTOR TBD®PERMIT ISSUANCE L8ILic.H <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> AT&T MOBILITY SUNNY AUSINK 206-446-0448 <br /> Phone/E-mail SAUS INK®PTSWA.COM <br /> BUILDING PERMIT APPLICATION CONTRt.CT PRICE OF WORK $15, 000 <br /> Existing Use of Building _ HEAT SOURCE: <br /> Proposed Use of Building___. _ - _-- .. Gas N/klectnc N/ADlter N/A <br /> Budding type: Single Family _Duple.c_Townhouse -Multi-Family Commercial <br /> Type of project: __New _Addition _Remodel _Repair_T.I._Sign_Sprinkler Demolition_Change of Use <br /> Description of Work(additional space provded on the back): <br /> AT&T proposes to modify the existing personal wireless facility by <br /> adding (3) new(LTE) antennas, adding (6) Remote Radio Heads (RRHs) units, <br /> Have you started working without a parrnit? YES x NO and (1) surge suppression to site. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _Now_Addn _Alteration_Repair Typo of Project: _New_Addn _Alteration_Repair <br /> Show Number(a)of fixtures Show Number(a)of fixtures <br /> 1 NC-air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> \4---\\IK_ <br /> Gas fireplace Kitchen sink 8 disposal <br /> Gas range Dishwasher <br /> Clothes dryer , Clothes washer <br /> e`` <br /> Range hood \ \ Water heater <br /> Exhaust fan Sink(serwce/bar/mopretc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> L Refrigeration Floor drain <br /> Woodslove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> INumber of Heads Other: <br /> — <br /> I . • certi • t I have read and examined this application and know the same to be true end correct.All p,pvrsans of laws and ordinances governing <br /> type of work Il be complied with whether specified herein or not.The granting of a permit does not presume to give authority to violate or cancel <br /> the provision of a other a e or local law recasting construction or the performance of construction.That I am authorized by the owner of this property <br /> to perform the • for ••'cation is made and I comply with the State Contractors Law 18.27 RCW and 2%200 WAC <br /> s I� I . . c9.611 <br /> Owner Aut • r... • • Date (Revised 217011) <br /> (/Z <br />