1321 COLBY AVE T MOBILE ANTENNAS 2021-11-10

• • 4rErr PERMIT APPLICATION BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 1321 Colby Avenue PROPERTY TAX#: 00438524600000 LEGAL for new construction: Short Plat/subdivision see legal sheet A-1 dwgs Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Providence Health & Services Washington TENANT NAME(If Commercial): T-Mobile OWNER MAILING ADDRESS: STREET 1801 Lind Ave SW#9016 CITY Renton STATE WA ZIP 98057 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: TBD - OUT TO BID k_ek ((rim LAM ► Ctun 0.11. CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): s I(-- L L- r CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Orr` PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR in OTHER(Please Specify) Authorized Agent CONTACT NAME: CONTACT PHONE: O: 206-523-1941 / M: 425.351.3392 Christine Contreras, on behalf of T-Mobile CONTACT EMAIL:ccontreras@rykaconsulting.com BUILDING PERMIT APPLICATION Existing Use of Building: Unmanned Wireless Communications Facility Contract Price of Work: $20,000 Proposed Use of Building: Unmanned Wireless Communications Facility Heat Source: ❑Gas DElectric DOther N/A Building Type: DSFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: ZCommercial ❑Industrial Type of Project: ❑New DAddition l/lRemodel DRepair ❑T.I. DSign ❑Sprinkler El Demolition DChange of Use DESCRIPTION OF WORK: Replace(3)existing canister shrouds with(3)new screen wall enclosure/box shrouds and attachments to existing penthouse roof structure,painted and textured to match existing building penthouse. Replace(3)and add(3)antennas and replace ancillary equipment and cabling on existing penthouse rooftop wireless facility.No height increase proposed and will not protrude beyond support structure. In indoor equipment room below,replace(2)equipment cabinets and ancillary equipment.No footprint expansion or ground disturbance,no new cabinets. ASSOCIATED BUILDING PERMIT#(if applicable): B1507-049 MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap _ Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan _ Sink(Service/Bar/Mop/etc.) Other: SPRINKLER/SUPPRESSION SYSTEM Number 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 1/5/21 � � � — C si OwnerWirthorized Ageg Signature Date (Revised 9/23/2016) ll�