3711 W MUKILTEO BLVD T MOBILE 2022-05-06

S • PERMIT APPLICATION BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (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:3711 W Mukilteo Blvd PROPERTY TAX#: 00433600002303(ground equipment)) LEGAL for new construction: Short Plat/subdivision see legal sheet A-1 dwqs Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Lakeshore Investment Corp TENANT NAME(If Commercial): T-Mobile OWNER MAILING ADDRESS: STREET 2633 Eastlake Avenue E CITY Seattle STATE WA ZIP 98102 OWNER PHONE: OWNER EMAIL: (� CONTRACTOR NAME: TBD- OUT TO BID 1kS T e G ��f r.( �L �s O II Ci ' S I Vl CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: v CONTRACTOR LICENSE#(REQUIRED): MAN 4 S T� ri b K N CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):TBD _ Al`T J PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ZI OTHER(Please Specify) Authorized Agent CONTACT NAME: CONTACT PHONE: 0: 206-523-1941 /M: 425.351.3392 Christine Contreras, on behalf of T-Mobile CONTACT EMAIL:ccontreras@rykaconsulting.com BUILDING PERMIT APPLICATION Existing Use of Building: Unmanned Wireless Communications Facility Contract Price of Work:$20,000 Proposed Use of Building:Unmanned Wireless Communications Facility Heat Source: ❑Gas ❑Electric DOther N/A Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: fiElCommercial ❑Industrial Type of Project: ONew ❑Addition ORemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Replace(2)antennas and remove/add/replace ancillary equipment and cabling on existing SnoPud utility pole located in the ROW.No height increase proposed. T-Mobile will also replace ground equipment inside of their existing existing lease area.No footprint expansion or ground disturbance. ASSOCIATED BUILDING PERMIT#(if applicable): B1211-033 MECHANICAL PERMIT APPLICATION IN/A PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair N/A #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain _ Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER/SUPPRESSIOTEM (Number of Heads N/A 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 8/31/21 PERMIT# g Z ( v — 055 owner uthorized Age Signature Date (Revised 9/23/2016) l f Z