9506 19TH AVE SE A T AND T ANTENNA 2022-03-03

• PERMIT APPLICATION. BUILDING I MECHANICAL / PLUMBING /SIGN / SPRINKLER / DEMOLITION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (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:9506 19TH AVENUE SOUTHEAST PROPERTY TAX#:28051800401700 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: CHJ Properties, LLC TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET 1833 N. 105th, Suite 303 c,TY Seattle STATE WA ZIP 98133 OWNER PHONE: 206.402.5567 OWNER EMAIL:hankjacky@yahoo.com CONTRACTOR NAME:Bluestream Professional Services CONTRACTOR ADDRESS: STREET 3305 HWY 60 W cin, Faribault STATE MN zip 55021 CONTRACTOR PHONE:814.312.2372 CONTRACTOR EMAIL:DUSTIN.QUEEN@KGPCO.COM CONTRACTOR LICENSE#(REQUIRED):603-209-450 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 57104 PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) Agent for AT&T Mobility CONTACT NAME: CONTACT PHONE:913-226-7438 Felicia Sauls CONTACT EMAIL:Felicia.Sauls@kgpco.com BUILDING INFORMATION Existing Use of Building:Commercial Contract Price of Work:$9200 Proposed Use of Building:Commercial Heat Source: OGas ❑Electric DOther BUILDING USE: ❑SFR ❑Townhouse Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure Type of Project: ❑New ❑✓Addition ❑Remodel Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition Change of Use DESCRIPTION OF WORK: Install backup diesel generator on 4' x 10' concrete pad in 13' x 8'6" compound lease area ASSOCIATED BUILDING PERMIT#(if applicable): V IX'O MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath.bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry, mop Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) Forced Air Systems Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER/ SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System 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 PERIVU5 _ /'/� 0,,,,�D2 Felicia Sauls � ^��@^��a�« 9/28/2020 '[J� ,- Owner/Authorized Agent Signature Date (Revised 10/10/2018) /