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PERMIT APPLICATION <br />BUILDING I MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everettehs0everettwa.aov I www.everettwa.aov/hermits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 6107 Berkshire Drive <br />PROPERTY TAX #: 28050600400900 <br />LEGALfor new construction: Short Plat/subdivision see legal sheet A-1 dwgs 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 />CITY Everett STATE WA zip 98201 <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: General Dynamics Info Tech <br />CONTRACTOR ADDRESS: STREET 19240 Des Moines Memorial Drive South Suite 300 <br />ciTv SeaTac STATE WA zip 98148 <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): GENERD1927CG <br />ICITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 054962 <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR 40 OTHER (Please Specify) Authorized Agent <br />CONTACT NAME: <br />Christine Contreras, on behalf of AT&T <br />ICONTACT PHONE: O: 206-523-1941 I M: 425.351.3392 <br />CONTACT EMAIL: ccontreras@rykaconsulting.com <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Unmanned Wireless Communications Facility <br />Contract Price of Work: $ 20,000 <br />Proposed Use of Building: Unmanned Wireless Communications Facility <br />Heat Source: ❑Gas ❑Electric ❑Other N/A <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi -Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition 14Remodel ❑Re air ❑T.I. ❑Sin ❑S rinkler ❑Demolition ❑Chan a of Use <br />DESCRIPTION OF WORK: <br />AT&T is proposing to replace three existing panel antennas, install six RRH units, install one Surge <br />Suppression unit, and remove ancillary equipment. No increase in height or ground disturbance. <br />ASSOCIATED BUILDING PERMIT # if applicable): B1604-059 <br />MECHANICAL PERMIT APPLICATION N/A <br />Type of Project: _New _ Addn _Alteration _Rep <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 />Backflow Preventer Inside Bldg) <br />Forced Air Sy stems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory ash 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/Bar/Mop/etc. <br />Other: <br />SPRINKLER <br />/ SUPPRESSION <br />—SYSTEM <br />Number of Heads <br />NIA <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 O)ficial O�ng authorized under any circumstance. I am the owner, or 1 am authorized by the owner of this property to perform the work for which application is made, <br />and 1 compbo4ith the State-Qontractors Law 18.27 RC Wand 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT# <br />lure a (Revised 9/2312016) <br />/ <br />