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PERMIT APPLICATION <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1(E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />(Blue or,Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 7410 Olympic Drive <br />PROPERTY TAX #: 00394000006600 <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: City Of Everett TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET 2930 Wetmore Ave <br />crhr Everett STATE WA <br />zi <br />OWNER PHONE: <br />OWNER EMAIL: CITY OF EVERFT-T- <br />CONTRACTOR NAME: To be determined at issuance 'L L "�'U/J/J L ermi ervice- s <br />CONTRACTOR ADDRESS: STREET <br />crr),y �� STATE UJ/// ZIP p> <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: QftW ^VA <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED)o1 <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR POTHER (Please Specify) Applicant <br />CONTACT NAME: <br />Max Kvern <br />CONTACT PHONE: 206-434-7019 <br />CONTACT EMAIL: max.kvern taec.net <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Water Tank Wireless Facility <br />Contract Price of Work: $ $20,000 <br />Proposed Use of Building: Water Tank Wireless Facility <br />Heat Source: ❑Gas ❑Electric ❑Other <br />Building Type: 14SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi -Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New I4Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler [Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />T-Mobile is proposing to modify an existing wireless facility located on a water tank. Please see building plans. <br />ASSOCIATED BUILDING PERMIT # if applicable): <br />M!Edi!AWICAL.PERMIT:APPLitAltidNI <br />PLUMBING PERMIT APPWCATION <br />Type of Project: _New Addn Alteration _Repair <br />Type of Project: _New _Addn _Alteration _Repair <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />Vst of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />A/C —Air Handling Units <br />Heat Pump <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />lKitchen Sink & Disposal <br />Grease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />Other: <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />Water Heater <br />Other: <br />Exhaust Fan <br />Sink Service/Bar/Mop/etc. <br />Other: <br />SPRINKLER <br />!,SUPPRESSION <br />SYSTEM <br />Chemical or Water I <br />INo. <br />of Heads <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 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />(Revised 912312016) <br />