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• PERMIT APPLICATIOA <br /> # I I I PI 4*‘/ 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:709 80th SW,Everett,WA 98023 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:American Tower Corporation TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 10 presidential Way <br /> CITY Woburn STATE MA zip 01801 <br /> OWNER PHONE:781-926-4583 OWNER EMAIL: <br /> CONTRACTOR NAME:Pioneer Communications Group <br /> CONTRACTOR ADDRESS: STREET 13430 NE 177th PI. <br /> CITY Woodinville STATE WA zip 98072 <br /> CONTRACTOR PHONE:425-890-1909 CONTRACTOR EMAIL:matt.bricknell@piogrp.com <br /> CONTRACTOR LICENSE#(REQUIRED):PIONECG903B0 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ®CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: Matt Bricknell CONTACT PHONE:425-890-1909 <br /> CONTACT EMAIL:matt.bricknell@piogrp.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ t7Ouj <br /> tas <br /> Proposed Use of Building: Heat Source: El Gas El Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: El Commercial El Industrial <br /> Type of Project: ❑New DAddition El Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK:-Extend existing H-Frame out from power meter-Install new NID on existing H-Frame-Install(2)new J-Boxes on new El-Frame-Install+/-14'of new fiber through(1)new 2"conduit from new J-Box <br /> #1(Fiber)Box)to existing CW Cabinet-Install+/-278'of new fiber through new 3"conduit with(2)1"inner ducts from PMMP to J-Box#1 <br /> PMMP Location.MMP is located on the West Side of 80th St.SW to the South Side of a utility pole(VZ 275690) <br /> Lat/Long:49.92566,-122.24302 <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 List of Fixtures #of List of Fixtures #of List of Fixtures #of 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.lam the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> C J G /9 PER D� 036 <br /> Owner/Aut rized Agent S Da (Revised 9/23/2016) <br /> 1� <br />