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PERMIT APPLICATIOI40 <br /> Ix 4111 BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps©everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink.Only Pleasm) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:4330 Rucker Avenue PROPERTY TAX#:00407800101300 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Michael and Cheryl Kane TENANT BUSINESS NAME(Commercial): T-Mobile <br /> OWNER MAILING ADDRESS: STREET 516 Cornelia Avenue <br /> c,r, Mukilteo STATE WA zP 98275 <br /> OWNER PHONE: Not available OWNER EMAIL:Not available <br /> CONTRACTOR NAMF•To be defprmioerl at issuance- 't "p�k e �ye,-C�� C� �� � ,) <br /> CONTRACTOR ADDRESS: STREET �✓ <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: p <br /> CONTRACTOR LICENSE#(REQUIRED):V S Vtc�/D CITY OF EVERETT BUSINESS LICENSE#(REQUI D)• "l -lam <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR El OTHER(Please Specify) Applicant / <br /> CONTACT NAME: CONTACT PHONE:(253)682-8556 <br /> T-Mobile do Technology Associates EC Inc.represented by Meghan Howey CONTACT EMAIL:meghan.howey©taec.net <br /> BUILDING INFORMATION <br /> Existing Use of Building:Telecommunication Contract Price of Work:$25,000 <br /> Proposed Use of Building:Telecommunication Heat Source: DGas DElectric DOther <br /> BUILDING USE: DSFR ❑Townhouse ❑Duplex ❑ADU OMulti-Family-#Units: ©Commercial ❑Accessory Structure <br /> Type of Project: ❑New IilAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: T-Mobile proposes modifications to an existing telecommunication facility per plans. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fin" Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System I No.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.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> Meghan HoweyDiaeaw�a�r PE111. 1,2 0 ziA <br /> 9 DOWNakedbYate WO. <br /> 12/1/2020 <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br /> k <br />