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PERMIT APPLICATION <br /> 'IPP/4404 --g BUILDING/ MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ' 3200 CEDAR STREET,EVERETT,WA 98201 ' <br /> (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 Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:5828 Glenwood Avenue PROPERTY TAX#: 28040100201200 <br /> LEGAL for new construction: Short Plat/subdivision see legal sheet T1 dwgs Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Public Utility Dist 1 Sn0 Co (SnoPud) TENANT NAME(If Commercial): New Cingular Wireless PCS, LLC. <br /> OWNER MAILING ADDRESS: STREET 2320 California Street <br /> CITY Everett STATE WA ZIP 98201 <br /> OWNER PHONE: 425-783-5681 (OWNER EMAIL: mmnave@snopud.com <br /> CONTRACTOR NAME: General Dynamics Info Tech <br /> CONTRACTOR ADDRESS: STREET 19240 Des Moines Memorial Drive South Suite 300 <br /> CITY SeaTac STATE WA zip 98148 <br /> CONTRACTOR PHONE: 425-201-4830 CONTRACTOR EMAIL:jay.kim©gdit.com <br /> CONTRACTOR LICENSE#(REQUIRED): GENERDI927CG CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):054962 <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ;EI OTHER(Please Specify)Authorized Agent <br /> CONTACT NAME: CONTACT PHONE: 0:206-523-1941 /M:425.351.3392 <br /> Christine Contreras on behalf of AT&T CONTACT EMAIL:ccontreras©rykaconsulting.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Unmanned Wireless Communications Facility Contract Price of Work:$90,000.00 <br /> Proposed Use of Building:Unmanned Wireless Communications Facility Heat Source: ['Gas DElectric ['Other N/A <br /> Building Type: ❑SFR-Detached ❑SFR-Attached El Duplex ❑Multi-Family-#of Units: IZICommercial ❑Industrial <br /> Type of Project: CI New ['Addition Il7Remodel ❑Repair CIT.!. OSign ['Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> AT&T proposes to remove the existing 113'-2"utility pole,mount and antennas and replace with a new 113'-2`high steel utility pole and install(6) <br /> antennas and related and relocated associated equipment and cabling. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): B1612-016/B1803-053-TO BE CLOSED and REPLACED <br /> MECHANICAL PERMIT APPLICATION N/A PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn _Alteration _Rep Type of Project: _New _Addn _Alteration _Repair `N/A I_ <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures I <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads N/A <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 /> City of Everett Official Use Only <br /> -7/ - PE:�T# cx,)5 <br /> Owner orized Agent Sig to (Revised-9/23/2096) . <br />