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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 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> ms's+..,y aTa"' a � :✓ Y ��, � �,x *':`< -�" "-�- �j*'� r `� ,� � - .� ..�.;- ,�` M1�"�, .. <br /> .. ., .�_._3 ,.. ,�_ „_.,. ivy�. .,r .::� E* WtN !� i y, :aa r''Ia''��` a2ec;ya'hitti" tM <br /> PROJECT SITE ADDRESS: 906 SE Everett Mall Way PROPERTY TAX#: 2805100308500 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) J <br /> *. A:` i .�. ,_ a!COOINTACt FORM C SIO+A . V , > ,. . .: ... tr.A .,� _ <br /> OWNER NAME: Pflueger Everett Holdings LLC TENANT NAME(If Commercial): T-Mobile <br /> OWNER MAILING ADDRESS: STREET 4250 Wilshire Blvd <br /> crry Los Angeles STATE CA ZIP 90010 <br /> OWNER PHONE: (425) 315-1354 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: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> Existing Use of Building: commercial Contract Price of Work:$ 25,000 <br /> Proposed Use of Building: n/a Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ®Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Modification of existing wireless facility including replacing three panel antennas and adding <br /> three RRH's. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MEC0ANICK`L PERMIT i1PpLiGAT ON ? ,. . , , >_..,<. PL1J BIN`.PE100rT P ,1cA O ,Wigan <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 /> 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.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#• ---� 3/2/16 ?21oO - <br /> Nel <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />