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gn- • PERMIT APPLICATION <br /> BUILDING / MECHANICAL / PLUMBING /SIGN / SRRINKLER / 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:6107 Berkshire Drive, Everett, WA 98203 PROPERTY TAX#:28050600400900 <br /> LEGAL for new construction: Short PlaVsubdivision N/A Lot No.N/A, (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: City of Everett TENANT BUSINESS NAME(Commercial): Tower Operator- Crown Castle <br /> OWNER MAILING ADDRESS: sTREET2930 Wetmore Ave <br /> CITY Everett STATE WA ZIP 98201 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME:TBD <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REOUIRED): 41 <br /> D�/3�/D <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR D OTHER (Please Specify) Authorized Agent <br /> CONTACT NAME: CONTACT PHONE:425-622-7879 <br /> Amanda Imper, SAC Wireless on behalf of T-Mobile CONTACT EMAIL:amanda.lmper@sacw.com <br /> BUILDING INFORMATION <br /> Existing Use of Building:Wireless Facility Contract Price of Work:$25,000 <br /> Proposed Use of Building N/ Heat Source: OGas tric DO+ler- <br /> BUILDING USE: Sf T nhouse — plex U JMlrtti-Fa sr- <br /> Uni' ____. --I... mmercial — rcessory Structure <br /> Type of Project:hNen w dition model pair mi.. hsign Sprinkler molition -in ange of Use <br /> DESCRIPTION OF WORK: <br /> T-Mobile proposes to replace existing Powergen 7500 APU Generator with New Generac 25kW gas gas generator <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures count List of Fixtures C nt List of Fixtures Count List of Fixtures <br /> A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> \ Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> -.Clothes Dryer Heat P &Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Ductyatem(Remodel) R Igeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(f esidential) ,,,"'Commercial Ventilation Floor Drain Toilet <br /> Exhaust Hood(Type I)\ -- (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type III Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) ood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems 1 Other: nerator Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log ----._______: Roof Drains Water Heater <br /> SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Cherrycal Suppression System No.of Heads <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 lam 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 /> PERMIT# 2 <br /> Amanda Imper "�""9"1°° 1/15/19 i� ( �C I + i J-7 <br /> Dale 2019.0 signed by <br /> 13mand-Imper' <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br />