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47.4.77 PERMIT APPLICATIOI' <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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:8401 Holly Drive PROPERTY TAX#:28051800201700 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:SfOhOmiSh County PUD TENANT NAME(If Commercial):T-Mobile <br /> OWNER MAILING ADDRESS: STREET PO Box 1107 <br /> CITY Everett STATE WA ZIP 98208 <br /> OWNER PHONE:425-783-5681 OWNER EMAIL: <br /> CONTRACTOR NAME:TBD Wire, <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: p �I r,W �j CC�ONTTRA�CTOR EMAIL: ®55� <� <br /> CONTRACTOR LICENSE#(REQUIRED) D cCLk)( L O J 2 3 / _ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR El OTHER(Please Specify) Centerline Solutions,Attn:Rick Stockmann <br /> CONTACT NAME: CONTACT PHONE:425 890-1437 <br /> Rick Stockmann CONTACT EMAIL:rstockmann@centerlinesolutions.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building:Utility Pole w/attached Wireless Facility Contract Price of Work: $15,000 <br /> Proposed Use of Building:Utility Pole w/attached Wireless Facility Heat Source: ❑Gas 0 Electric ❑Other N/A <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: EICommercial ❑Industrial <br /> Type of Project: ❑New RAddition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Remove 3 existing RRUs and replace with 4 new RRUs. <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 r 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.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 C00t actors Law 18.27 RCW and 296.200A WAC. <br /> PERMIT# City of Everett Official Use Only <br /> i I <br /> 0, ner/Authorized Agent Signature Date (Revised 5/20/2016) <br /> . 2- <br />