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• PERMIT APPLICATION* <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />OL 3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 l FAX 425-257-8857 1 (E) everetteps@everettwa.gov l www.everettwa.gov?permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 6107 BERKSHIRE DR <br />1PROPERTY TAX #: 28050600400900 <br />LEGAL for new construction: Short PlaUsubdivision see legal sheet A 1 d`.vgs Lot No_ (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: City Of Everett TENANT NAME (If Commercial): New Cingular Wireless PCS, LLC. <br />OWNER MAILING ADDRESS: STREET 3002 Wetmore Ave <br />C,T,- Everett STATE WA ZAP 98021 <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: General Dynamics Info Tech <br />CONTRACTOR ADDRESS: STlll 19240 Des Moines Memorial Drive South Suite 300 <br />CA," SeaTac s7AT- WA z,, 98148 <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />4 77— <br />CONTRACTOR LICENSE #tREQUIRED): GENERD1927CG <br />ICITY OF EVERETT BUSINESS LICENSE #(REQUIRE6):054962 <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR Z) OTHER (Please Specify) Authorized Agent <br />CONTACT NAME: <br />Chris DeVoist <br />CONTACT PHONE: O: 206-523-1941 / M: 206-949-3321 <br />CONTACT EMAIL: Cdevoist@rykaconsti(ting.com <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building Unmanned Wireless Communications Facility <br />Contract Price of Wor 15,000 <br />Proposed Use of Building Unmanned Wireless Communications Facility <br />lHeat Source: ❑Gas ,, ❑Electric 00ther <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi -Family-» of Units: ❑ bmmercial ❑Industrial <br />Type of Project ❑New ❑Addition OPemodel ❑Repair ❑T.I ❑Sign ❑Sprinkler ❑0enl66on ❑Change of Use <br />DESCRIPTION OF WORK: AT&T proposes to remove (3) antennas, replace (3) antennas, add (6) remote radio units <br />and associated ancillary support equipment and hardware. <br />ASSOCIATED BUILDING PERMIT # (if applicable) <br />MECHANICAL PERMIT APPLICATION NIA <br />Type of Project: _New Addn Alteration Repa <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New Addn Alteration Repair <br />N/A <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />A C - Air Handling Units <br />Heat Pump <br />Toilet <br />Beckflow Preventer Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />Kitchen Sink & Disposal <br />Grease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />Other <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />Water Heater <br />Other: <br />Exhaust Fan <br />Sink (Service;BariK1op.-etC.) <br />Other <br />SPRINKLER <br />I SUPPRESSIO <br />_,SYSTEM <br />Number of Heads <br />1"jlA ` <br />ACKNOWLEDGEMENT. l crave reweived flits application and confiRrr the information contained herein is true and correct. Work done pursuant to tors permit must comply with <br />current federal, state, and local taw The granting of a permit only authorizes approved work and no deviations therefrorrc DevaUons must rirst be authorzed in wnring from the <br />Building Offielal before DekV authonzed under any urcumstance. i am the owner, or l am authorized by the owner of th.rs property to perform the work for wtucn appPeation is made, <br />and I comply Will) the State �rntraC�tors Law 18.27 RCW and 296.200A WAC <br />City of Everett Official Use Oruy <br />PERkI(T ` _ O 2Co <br />Owner/Authorized Agern Signature Date (Revised 99/23/2016) <br />