1321 COLBY AVE VERIZON WIRELESS ANTENNAS 2021-11-01

_ • 40 PERMIT APPLICATION 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 Ofnly PlsasE) PROJECT SITE;INFORMATION " , :` PROJECT SITE ADDRESS:1321 COLBY AVE. EVERETT WA 98201 PROPERTY TAX#:00438524600000 LEGAL for new construction: Short Plat/subdivision Section 18ToamahIp29 Range O5 Quarter SES,bdMislm Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: PROVIDENCE HEALTH &SERVICES WA TENANT BUSINESS NAME(Commercial): Verizon Wireless OWNER MAILING ADDRESS: STREET 1801 LIND AVE. SW#9016 ci y Renton STATE WA zip 98016 OWNER PHONE: N/A OWNER EMAIL:N/A CONTRACTOR NAME:TBD �_ �`Pkl l lIJ TrA,e( Q*i )VLc • CONTRACTOR ADDRESS: STREET N/A �v� / )j ;sj/(J /6 {, "� ,, , CITY N/A iifrei ? � STATE N/A W M Ul S ZIP N/A 7 )2 ott CONTRACTOR PHONE:N/A CONTRACTOR EMAIL:N/A CONTRACTOR LICENSE#(REQUIRED):N/A 6U,L.T(, gkii.661 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): G I 1p_1 N/A PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR D OTHER(Please Specify) Applicant Agent CONTACT NAME: CONTACT PHONE:(978)697-5295 Odelia Pacific -Allyson Kilcoyne CONTACT EMAIL:akilcoyne@odelia.com BUILDING INFORMATION . . Existing Use of Building:Medical and Other Health Services Contract Price of Work:$ Proposed Use of Building:No Change Heat Source: ❑Gas ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ©Commercial ❑Accessory Structure Type of Project: ❑New ❑✓Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Verizon is proposing to modify an existing telecommunications facility by adding three(3)new antennas. ASSOCIATED BUILDING PERMIT#(if applicable): B0g10-035 MECHANICAL PERMIT APPLICATION;` PLUMBING PERMIT APPLICATION Fixture Flrture 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 f 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.lam 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 /1acb 02/11/2021 PERMITS l O" 66 {J, Owner/A orized Agent Signatf/'e Date (Revised 10/10/2018) 1k