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S <br /> grr PERMIT APPLICATION <br /> 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 <br /> Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: I I 1 2th St SE Everett, WA 98208 PROPERTY TAX#: 2805 1 900401 000 <br /> LEGAL for new construction: kiof'lstAivision see legal sheet A-1 dwgs Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: HIR 3 Tacoma Place, LLC TENANT NAME(If Commercial): T-Mobile <br /> OWNER MAILING ADDRESS: STREET PO Box 5003 <br /> CITY Bellevue STATE WA ZIP 98009 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: TBD- OUT TO BID <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ZI OTHER(Please Specify) Authorized Agent <br /> CONTACT NAME: CONTACT PHONE: 0: 206-523-1941 /M: 425.351.3392 <br /> Christine Contreras, on behalf of T-Mobile CONTACT EMAIL:ccontreras@rykaconsulting.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Unmanned Wireless Communications Facility Contract Price of Work:$20,000 <br /> Proposed Use of Building: Unmanned Wireless Communications Facility Heat Source: ❑Gas ❑Electric ❑Other N/A <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: glCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ORemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Replace(3)and add(3)antennas and replace ancillary equipment and cabling on existing SnoPud utility pole.No height increase proposed. <br /> T-Mobile will also replace ground equipment inside of their existing fenced lease area.No footprint expansion or ground disturbance,no new equipment <br /> cabinets proposed. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): B1706-003 <br /> MECHANICAL PERMIT APPLICATION IN/A 4 PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repailr Type of Project: _New _Addn _Alteration _Repair N/A L <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <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/SUPPRESSIONSYSTEM <br /> (Number of Heads IN/AI <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!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 /> 5/4/21 PERM( #�\O Cj b 1 <br /> Owner uthorized Abe >Signature Date (Revise 9/23/2016) <br /> �Z <br />