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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS; PROPERTY TAY s P. RMIT <br /> 9610 19th Ave . SE, Everett, WA 98208 2ap51Q, od�-DogOo X3®1 -03g <br /> LEGAL for new construction: Short Plat/subdivision _Lot No. (attach copy of long legal description) <br /> OWNER SBA/AAT Communications Phone/E-mail jrozanc@sbasite . com 702-581-2663 <br /> Address 1244 Powerscout Drive, Suite 30 �ity/State/Zip St . Louis, MO 63131 <br /> APPLICANT: Owner XOwner's Agent _Contractor Contractor's Agent Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR David Zigler/Westower L&I Lic.# WESTOC1975J8 COE Bus. Lic.# <br /> Address 405 Evans Black DR , Tukwila, WA 98108 Phone/Email 206-373-1229 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT Tony Phillips <br /> Tony.phillips@clearwire . com <br /> Clear Wireless, LLC Phone/E-mail 847-331-3659 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK $5500 . 00 <br /> Existing Use of Building Wireless Facility HEAT SOURCE: <br /> Proposed Use of Building Same Gas Electric Other <br /> Building type: Single Family Duplex Townhouse _Multi-Family X Commercial <br /> Type of project: New X Addition Remodel Repair_T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Adding One (1) antenna and an accompanying radio to an already existing <br /> wireless facility. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping ! Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range I Dishwasher <br /> _ Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> • Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certify that I have read and examined this application and know the same to be true and correct.All provisions of laws and ordinances governing this type of work will be complied <br /> with whether specified herein or not.The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> That 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. <br /> NI I <br /> Owner/Authorized Agent Signature Date (Revised 6/2012) <br />