2215 MERRILL CREEK PKY T MOBILE ANTENNA 2021-11-15

• PERMIT APPLICATIOI 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: 2215 Merrill Creek Pkwy,Everett,WA 98203 PROPERTY TAX#: 28040200300300 --SEC 02 TWP 28 RGE 04LOT 3A SEAWAY ENTER ONEB.S.P.REC VOL 1 B.S.P.PGS 160 THROUGH.163 AF 8906295003&B.S.P.CERT AF NO 8906290451&BEING PTN NE1/4 SW1/4 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Polo Properties LLC TENANT NAME(If Commercial): T-Mobile OWNER MAILING ADDRESS: STREET 3248 Hunts Point Rd CITY Hunts Point STATE WA ZIP 98004 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: SAC Wireless LLC CONTRACTOR ADDRESS: STREET 540 Madison St CITY Chicago STATE IL ZIP 847-944-1600 CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): SACWIWL852J2 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ®OTHER(Please Specify) Authorized Agent CONTACT NAME: CONTACT PHONE: 206-336-3204 Sarah Baird, Crown Castle, on behalf of T-Mobile CONTACT EMAIL: sarah.baird@crowncastle.com BUILDING PERMIT APPLICATION Existing Use of Building: Wireless Communications Facility Contract Price of Work:$ 30,000 Proposed Use of Building: No change Heat Source: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units:_ ®Commercial ❑Industrial Type of Project: ❑New ❑Addition ®Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: T-Mobile proposes to replace(4)antennas;remove(1)RRU,(1)junction box,and(3)TMA's;and install(2)antennas,(1)junction box,and(2)HCS cables on existing tower.T-Mobile also proposes to replace(2)cabinets;remove(1)cabinet,(6)diplexers,(1)junction box,all FRIA,all ESMB,all FSME,all ESMB,and (2)AMOB;relocate(6)modules;and install(1)FSMF,(1)FBBC,(4)AMIA with(50)modules,and(1)CSR within existing compound. ASSOCIATED BUILDING PERMIT#(if applicable): 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 I SUPPRESSION SYSTEM Chemical or Water 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 PERMIT# a /1 1 10/2/2019 P) 1q 1D+a? Owner/Authorized Ag- !nature Date (Revised 9/23/2016)