3200 20TH ST VERIZON ANTENNA 2022-08-17

OLT • 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:3200 20TH Street PROPERTY TAX#:00563241100100 LEGAL for new construction: Short Plat/subdivision• Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Washington State Department of Transportation TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET PO Box 330310 cm( Seattle STATE WA ZIR 98133 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME:TBD 0`y(:�' L (- CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): 41l I/ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ( -1 ( 3 PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR D OTHER(Please Specify) Tilson representing Verizon CONTACT NAME: CONTACT PHONE:509.998.9015 Angela Raymond CONTACT EMAIL:araymond@tilsontech.com BUILDING INFORMATION Existing Use of Building:WCF Contract Price of Work:$20,000 Proposed Use of Building:WCF Heat Source: ❑Gas ❑Electric ❑Other N/A BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑✓Remodel ❑Repair ❑T.I. ❑Sign Sprinkler El Demolition ❑Change of Use DESCRIPTION OF WORK: Verizon is proposing to modify an existing 150' monopole. Removal of 1 OVP at monopole and 1 OVP at shelter. The installation of 3 RRUs and antennas combo, 1 OVP at monopole and 1 OVP at shelter. No additional height is p proposed and no ground disturbance. ASSOCIATED BUILDING PERMIT#(if applicable): 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 Ventilatior 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 PERMI � D \ / Angela Raymond Digitally '�-0800nd 1/22/2021 IIUn Owner/Authorized Agent Signature Date (Revised 10/10/2018)