9830 EVERGREEN WAY T MOBILE ANTENNAS 2021-09-23

PERMIT APPLICATIOlik LS BUILDINOECHANICAL/PLUMBING/SIGNWPRINKLER/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 P1.as40): PROJECT SITE INFORMATION PROJECT SITE ADDRESS:9830 Evergreen Way PROPERTY TAX#:28041300305300 LEGAL for new construction: Short Plat/subdivision See FCDs Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: P TENANT BUSINESS NAME(Commercial): T-Mobile OWNER MAILING ADDRESS: STREET PO Box 1107 (*r uCt.._ •#4-4.0 _, city Everett STATE WA ZIP 98206 OWNER PHONE: 425-267-6135 OWNER EMAIL:bahaskin@snopud.com CONTRACTOR NAME:} („re_ F' G4 _e_C) ..jp," :".".4—Sc.,,,'"."),.....elc-ea.)%6 CONTRACTOR ADDRESS: STREET CITY se p eako,cf3L, ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) Authorized Agent for T-Mobile. Lynx Consulti! CONTACT NAME: CONTACT PHONE:509-551-1027 Dash Miller CONTACT EMAIL:dmiller@lynxconsulting.org BUILDING INFORMATION Existing Use of Building:Wireless Communications Facility(Pole) Contract Price of Work:$57,000 Proposed Use of Building:No change of use Heat Source: ❑Gas ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ElAccessory Structure Type of Project: ❑New ❑✓Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Modification to existing wireless communications facility including the addition and replacement of antennas and replacement of radios and other ancillary equipment. ASSOCIATED BUILDING PERMIT#(if applicable): 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 A/C—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 l SUPP,RESSION,SYSTEM , Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System I 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 Dash Miller a202000231.330� o., .t,,..��,�� PE #GS) , elk Owner/Authorized Agent Signature Date (Revised 10/10/2018) 1,2._