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OLT 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: 220 Olympic Blvd.,Everett,WA 98203 PROPERTY TAX#: 006062-000-041-02 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)See Property Report <br /> CONTACT INFORMATION <br /> OWNER NAME: Global Signal Acquisitions IV LLC TENANT NAME(If Commercial): T-Mobile <br /> OWNER MAILING ADDRESS: STREET PO Box 277455 <br /> ciTY Atlanta STATE GA ZIP 30384 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: TBD <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 ❑CONTRACTOR ®OTHER(Please Specify) Agent <br /> CONTACT NAME: CONTACT PHONE: 206-336-3204 <br /> Sarah Baird,Crown Castle,on behalf of T-Mobile CONTACT EMAIL: <br /> sarah.baird@crowncastle.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Wireless Communications Facility Contract Price of Work:$ 20,000 <br /> Proposed Use of Building: No change Heat Source: ❑( s ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units ®Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition 2Remodel ❑Repair ❑T.I. ❑Sign ❑Sprink ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> T-Mobile proposes to replace(3)antennas and(3)RRU's;and remove(12)diplexers and(6)coax lines on existing tower.T-Mobile <br /> also proposes to replace(1)cabinet;relocate(2)system modules;and install(8)modules and(1)CSR within existing compound. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of #of List of Fixtures List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—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/SUPPRESSION SYSTEM <br /> Chemical or Water 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.I am the owner,or I 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 /> PERMI • <br /> a,cn��i�� I 8/22/2019 I 0 i 0� <br /> Owner/Authorized Age'Mr' ature Date (Revised 9/23/ 016) <br /> 1 <br />