1321 COLBY AVE VERIZON WIRELESS ANTENNAS 2021-02-22

PERMIT APPLICATI• BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS:1321 Colby Ave PROPERTY TAX#:00438524600000 LEGAL for new construction: Short Plat/subdivision on plans- not new conts. Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Providence Health &Services WA TENANT BUSINESS NAME(Commercial): Verizon OWNER MAILING ADDRESS: STREET 1801 Lind Ave SW CITY Renton STATE WA ZIP 98057 OWNER PHONE: 425-261-3746 OWNER EMAIL:peter.smeltz@providence.org CONTRACTOR NAME:TBD at later-date- CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED - LT'e_$g,t4C PICITY OF EVERETT BUSINESS LICENSE#(REQUIRED):� (p( PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR OTHER(Please Specify) RE consultant CONTACT NAME: CONTACT PHONE:425 530 2945 Les Cooley CONTACT EMAIL:les@sage-hill.com BUILDING INFORMATION Existing Use of Building:Hospital Contract Price of Work:$ 12,800.00 Proposed Use of Building:Hospital Heat Source: ❑Gas DElectric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure Type of Project: ❑New ❑✓Addition ❑Remodel El Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Remove 3 antennas and replace with 3 new antennas, add 2 OVP's and add 3 RRu's. Remove 12 diplexers. ASSOCIATED BUILDING PERMIT#(if applicable): none MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures NC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub, or Combo Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil .Water Service(behind meter) Forced Air Systems Other Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System No.of Heads 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 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 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, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PER ^ ,� ,, ^ OO2 Lester Cooley �.-�. �,m�,.-� 2/28/20 /)�IIIJFIJ��/ Owner/Authorized Agent Signature Date (Revised 10/10/2018) . l