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• <br /> gn- PERMIT APPLICATION <br /> BUILDING I 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: 1931 W Mukilteo Blvd PROPERTY TAX#: 00417100004703 <br /> LEGAL for new construction: Short Plat/subdivision see legal sheet A-1 dwgs Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Leona Chase TENANT NAME(If Commercial): T-Mobile <br /> OWNER MAILING ADDRESS: STREET 1931 W Mukilteo Blvd <br /> CITY Everett STATE WA ZIP 98203 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: SAC Wireless LLC <br /> CONTRACTOR ADDRESS: STREET 1037 Thomas Ave SW, Suite 1037 <br /> CITY Renton STATE WA ZIP 98055 <br /> CONTRACTOR PHONE: 425-223-7982 CONTRACTOR EMAIL: tommy.carlson@nokia.com <br /> CONTRACTOR LICENSE#(REQUIRED): SACWIWL852J2 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):TBD' > <br /> PRIMARY CONTACT: D OWNER ❑CONTRACTOR ,J OTHER(Please Specify) Authorized Agent <br /> CONTACT NAME: CONTACT PHONE: 0: 206-523-1941 / M: 425.351.3392 <br /> Christine Contreras, on behalf of T-Mobile CONTACT EMAIL:ccontreras@rykaconsulting.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Unmanned Wireless Communications Facility Contract Price of Work:$20,000 <br /> Proposed Use of Building: Unmanned Wireless Communications Facility Heat Source: ❑Gas ❑Electric DOther N/A <br /> Building Type: DSFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: ZCommercial ❑Industrial <br /> Type of Project: ❑New DAddition VIRemodel ❑Repair ❑T.I. DSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Replace(2)antennas and remove/add/replace ancillary equipment and cabling on existing SnoPud utility pole located in the ROW. No height increase <br /> proposed. <br /> T-Mobile will also replace ground equipment inside of their existing equipment shelter.No footprint expansion or ground disturbance. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): B1508-041 <br /> MECHANICAL PERMIT APPLICATION ,J/A 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 /> NC—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 /> • <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 /> Number 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 /> Lam'' 8/421 PERMIT# I ry I <br /> Owner:Authorized Agent Signature Date (Revised 9/23/2016) }V( <br /> i <br />