8401 HOLLY DR T MOBILE 2023-04-24

• • PERMIT APPLICATION BUILDING/MECHANICAL/PLUMBING /SIGN/SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION 28051800201700 PROJECT SITE ADDRESS:8401 Holly Drive PROPERTY TAX#:28051800201100 LEGAL for new construction: Short Plat/subdivision see legal sheet A-1 dwgs Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Grace Lutheran Church-Everett TENANT NAME(If Commercial): T-Mobile OWNER MAILING ADDRESS: STREET 8401 Holly Drive CITY Everett STATE WA ZIP 98208 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: TBD - OUT TO BID CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): MASTS 4 S 81(O K 0 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5+f t3 PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 4 OTHER(Please Specify)Authorized Agent CONTACT NAME: CONTACT PHONE: 0: 206-523-1941 /M: 425.351.3392 Christine Contreras, on behalf of T-Mobile CONTACT EMAIL:ccontreras@rykaconsulting.com BUILDING PERMIT APPLICATION Existing Use of Building: Unmanned Wireless Communications Facility Contract Price of Work:$20,000 Proposed Use of Building: Unmanned Wireless Communications Facility Heat Source: ❑Gas ❑Electric ❑Other N/A Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: 4Z1Commercial ❑Industrial Type of Project: ONew ❑Addition IZRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ODemolition ❑Change of Use IESCRIPTION OF WORK: T-Mobile is proposing to add(3)panel antennas, replace(3)panel antennas,and replace/add ancillary equipment on the existing SnoPud utility pole located in the ROW.Additionally,T-Mobile will be replacing ground equipment inside of their existing fenced lease area. No increase in height or projection and no ground disturbance is proposed. No increase in the number of equipment cabinets. ASSOCIATED BUILDING PERMIT#(if applicable): B1607-009 MECHANICAL PERMIT APPLICATION IN/AI PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn _Alteration _Reps r Type of Project: _New _Addn _Alteration _Repair N/A L Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER I SUPPRESSION TEM....1 (Number of Heads N/A 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 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 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, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only 6/11/21 PERMIT# 0 Z1 O( - 031 Owner uthorized Age Signature Date (Revised 9/23/2016) fa