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M] <br />PERMIT APPLICATION <br />BUILDINGRIECHANICAL / PLUMBING / SIGN / 4SPRINKLER / 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: 319 76th St SW, Everett, WA 98203 <br />PROPERTY TAX #:003BEVERL0-060-05 <br />LEGAL for new construction: Short Plat/subdivision Lot No. attach co of Ion legal description) tion) 3 E -00 -0 LESS BLDG ONLY ON <br />( PY 9 9 P ssza-ooa-osa-osoz <br />CONTACT INFORMATION <br />OWNER NAME: City of Everett TENANT NAME (If Commercial): T-Mobile <br />OWNER MAILING ADDRESS: STREET 3002 Wetmore Ave <br />CITY Everett STATE WA zip 98201 <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: T A �� <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED)5 ��,� VJ vV 2< %, <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 9F)IN <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR VOTHER (Please Specify) Authorized Agent <br />CONTACT NAME: <br />Sarah Baird, Crown Castle, on behalf of T-Mobile <br />CONTACT PHONE: 206-336-3204 <br />CONTACT EMAIL: sarah.baird@crowncastle.com <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Wireless Communications Facility <br />Contract Price of Work: $ 20,000 <br />Proposed Use of Building: No change <br />I Heat Source: ❑Gas ❑Electric ❑Other N/A <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi -Family-# of Units: EYCommercial ❑Industrial <br />Type of Project: ❑New ❑Addition [&Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />T-Mobile proposes to replace (3) antennas, (3) RRU's, (1) COVP, and (1) hybrid cable system on existing tower. T-Mobile also proposes to replace (3) cabinets; <br />relocate (6) modules and (1) CSR; remove (4) modules and (1) COVP; and install (2) COVP and (7) modules within existing compound. <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <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 />List 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 />Kitchen 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 <br />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. 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 />7/29/2019 <br />Signature <br />City of Everett Official Use Only <br />PERMIT# <br />(Revised 912312016) <br />l <br />