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III <br /> WA2821 <br /> 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 /> II pp gg APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> 53200D20thSSt. Everett, WA 98201 P00563241100100 PF.,RMITtl ._ , /� r-: <br /> 7 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) V <br /> OWNER Washington St. Dept. Transportation Phone/E-mail <br /> Address PO Box 330310 City/State/Zip Seattle, WA 98133 <br /> APPLICANT:_Owner _Owner's Agent Contractor X Contractor's Agent Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR Westower Communications L&I Lic.# WESTOC1975J8 COE Bus. Lic.# 041551 <br /> Address7525 24th Ave SE #500 Mercer Island,WAPhone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT Jesse London <br /> AT&T MOBILITY <br /> Phone/E-mail j london@rykaconsulting. corn <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK $15, 000 <br /> Existing Use of Building_Unmanned Wireless Communications Facility HEAT SOURCE. <br /> Proposed Use of Building L 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 /> AT&T proposes to replace six antennas with six new panel antennas and associated ancillary equipment, all on al <br /> existing monopole. <br /> MECHANICAL PERMIT APPLICATION N/A 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 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 spec' d herei/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 autho d by th owner oft s 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 /> / 0 2 /Lq /1 61- Ili— <br /> Owner' uthori ed Agent Signature Date (Revised 6/2012) <br />