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PERMIT APPLICATI011� <br /> BUILDING/MECHANICAL/PLUMBING /SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)42�257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.govJpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1118 80th Street SW PROPERTY TAX#: 00392200001700 <br /> LEGAL for new construction: Short PlaUsubdivision See 12q81 Sh88t A-1 dWqS Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Bottling Group LLC TENANT NAME(If Commercial): New Cingular Wireless PCS, LLC. <br /> OWNER MAILING ADDRESS: srReeT 1412 Main Street, Suite 1500 <br /> o�TY Dallas STATE TX ziP 75202 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: G@Il@faI Dyt18I'T11CS ItlfO T@Ch <br /> CONTRACTORADDRESS: srReer 19240 Des Moines Memorial Drive South Suite 300 <br /> arv SeaTac STATE WA ziP 98148 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR uCENSE#�ReQuiRe��: GENERDI927CG CITY OF EVERETT BUSINESS UCENSE#(REQUIRED):O549GZ <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR �OTHER(Please Specify) Authorized Agent <br /> CONTACT NAME: CONTACT PHONE: O: 206-523-1941 1 M: 425.351.3392 <br /> Christine Contreras, On b@half Of AT&T coNTacT enn�u�:ccontreras@rykaconsulting.com <br /> " BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Unmanned Wireless Communications Facility Contract Price of Work:$20 000.00 <br /> Pro osed Use of Buildin : Unmanned Wireless Communications Facility Heat Source: ❑Gas ❑Electric ❑Other N/A <br /> Buildin T e: ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famil -#of Units: ❑Commercial ❑Industrial <br /> T e of Pro'ect: ❑New ❑Addition ORemodel ❑Re air ❑T.I. ❑Si n ❑S rinkler ❑Demolition ❑Cha e of Use <br /> DESCRIPTION OF WORK: <br /> Replace (3) existing antennas, add (6) new remote radio heads, and (1) Surge Suppression unit on <br /> existing lattice tower. No increase in height or ground disturbance. <br /> ASSOCIATED BUILDING PERMIT# if a licable : B1610-048 <br /> MECHANICAL PERMIT APPLICATION N�A PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn Alteration _Rep Type of Project: _New _Addn Alteration _Repair N/A <br /> #of List of Fixtu�es #of List of Fixtures #of List of Fixtures #�f List of Fixtures <br /> Fixtures Flxtures Fixtures Flxtures <br /> A!C—Air Handli Units Heat Pump Toilet Backflow Preventer Inside Bld <br /> Forced Air S s#ems Unit Heater Bathtub Urinal <br /> Gas Pi in Boiler Lavator ash Basin Drinkin Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Fire lace Wood Stove Kitchen Sink&Dis osal Grease Tra <br /> Gas Ran e Ducti Dishwasher Roof Drains <br /> Clothes D er Hooku s Other: Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink Service/Bar/Mo /etc. Other: <br /> SPRINKLER/SUPPRESSIO TEM <br /> Number o Hea s N/A <br /> ACKNOWIFDGEMFNT:1 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 onfy authorizes approved work arrd no deviations therefrom.Deviations must first be authoriz�in writing from the <br /> 8uilding Official before being authorized under any circumstance.1 am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERM # <br /> �O � I_ �� <br /> OwnedB iBrR gent Signature Date (Revlsed 9/23�2016) %�� <br /> f <br /> E <br /> �`�_-__-__,_.. �.�� <br />