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477 • 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 Please), PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:5818 Glenwood Ave, Everett,WA 98203 PROPERTY TAX#:28040100201200 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Snohomish County PUD TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 1802 75TH Street SW <br /> ciTY Everett STATE WA ZIP 98203 <br /> OWNER PHONE: 425.78 .5606 OWNER EMAIL: <br /> CONTRACTOR N E:TBD 1 <br /> CONTRACTOR ADDRE 5. 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 0 OTHER(Please Specify) Applicant <br /> CONTACT NAME: CONTACT PHONE:509.998.9015 <br /> Angela Raymond CONTACT EMAIL:araymond@tilsontech.com <br /> BUILDING INFORMATION <br /> Existing Use of Building:Monopole Contract Price of Work:$10,000 <br /> Proposed Use of Building:Monopole Heat Source: OGas ❑Electric ❑Other N/A <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure <br /> Type of Project: :New ['Addition ❑Remodel ['Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ['Change of Use <br /> DESCRIPTION OF WORK: Verizon is proposing to modify an existing 113'.2"monopole. The modification will not increase the <br /> height nor propose any ground disturbance. The scope of work includes removal of 6 antennas. Installation of 3 antennas, <br /> 3 RRU/antenna combo, 1 OVP and hybrid cable to existing antenna platform. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fame Fixture Fixture <br /> Count List of Fixtures CountList of Fixtures Count List of Fixtures Count List of Fixtures <br /> NC—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 Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System I 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.lam 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#Angela Raymond D 2p1e Dam 2 z,oa14074852-0To Ca 4/14/20210 U R.Ym <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br />