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0 PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING I SIGN I SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everettepsgeverefta,gov I wwwaverettwa gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1321 Colby Avenue 1PROPERTY TAX M. 00438524600000 <br /> LEGAL for new construction: Short Plat/subdivisimShe legal shee#A- wk§' Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME- Providence Health &Services of Washington TENANT NAME(if Commercial): New Cingular Wireless PCS. LLC. <br /> OWNER MAILING ADDRESS:., sTRE,-T 1801 Lind Ave SW#9016 <br /> OWNER PHONE: My Renton —TOWNER EMAIL: srATE WA zP 98057 <br /> CONTRACTOR NAME: General Dynamics Info Tech <br /> CONTRACTOR ADDRESS: s-mEET 19240 Des Moines Memorial Drive South Suite 300 <br /> crry SeaTar, STATE WA zrP 9$148 <br /> CONTRACTOR PHONE: --[CONTRACTOR EMAIL. <br /> CONTRACTOR LICENSE#(REQUIRED): GENERD1927CG 1CrrY OF EVERETT BUSINESS LICENSE#(REQUIRED}'054962) <br /> PRIMARY CONTACT: 171 OWNER 11 CONTRACTOR 4 OTHER(Please Specify),kuthori?eti Ag�t1t ---- <br /> CONTACT NAME: CONTACT PHONE: 0: 206-523-1941 /M: 206-949-3321 <br /> Chris DeVoist CONTACT EMAIL:Cdevoist@rykacansulting.com <br /> BUILDING PERMIT APPLICATION <br /> Existing use of Building: Unmanned Wireless Communications Facility Contract price of Woik:$5,000 <br /> Proposed Use of Building: Unmanned Wireless Communications Facility lHeat Source: OGarsOEIoctric 110ther <br /> Building Typa 0SI`R-Detached OSFR-Attached ©Duplex OKlulti-Famity-Aft of Units: IlCommorcial Dindustrial <br /> Type of Project: ONew DAddition ORemodel []Repair 11[-1- O'Sign []Sprinkler ElDemolitton E]CtWK)e of Use <br /> DESCRIPTION OF WORK: AT&T proposes to replace(3)existing small remote radio units,with(3)replacement units, <br /> at an existing rooftop wireless facility, <br /> ASSOCIATED BUILDING PERMIT#(it applicable) <br /> , MECHANICAL PERMIT APPLICATION NIA PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn _Alteration --R _New of Project: w _Addn Alteration Repair <br /> #of #of #of #of <br /> Fixtures List of Fixtures FFixtures 'ist of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> ackflow Preventer(inside Bldg) <br /> AiC-Air Handling Units Heat Pump Toilet <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&-Disposal lGrease Trap <br /> Gas Rance Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other Clothes Washer Medical Gas <br /> Range Hood Water Heater Other_ <br /> lExhaust Fen Sink(Servicie-flBarNwete.} Other <br /> SPRINKLER I SUPPRESSION-%Y$TEM <br /> INumber'ofHeads IN/Ar— <br /> ACKNOWLEDGEMENT-I have reviewed ties aPPh1caWn and confirm the Warination confawd herein is tam and correct.Wank dome purserant to h.s permit must �tk with <br /> current rederal,stare,aV bcai kiw The granWV of a pemyt oa1y,*dhw-,es approved wolk and 00 deviamns nieretrom_oev&wians nzt first be a&twized w wnMV trom the <br /> Bijd&V Oflltaal W(Ve 6"aWh0flZed Wider any CIMUMstarrce i am the owner,or I am aummaed by the om*t of ttm property to perlwm the wont for whch appbmtm Is Made, <br /> and I cmpty vOn Me State GonfraCtors Law f8.27 RCW and 296,2"WAC, City of Everell Officiztl Use <br /> Orly <br /> Dave (Revised 9123120161 <br /> Owner/Authornted Agent Sigiriature <br />