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PERMIT APPLICATION <br /> BUILDING / MECHANICAL / PLUMBING 1 SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-88'10 1 FAX 425-257-8857 1(E)everetteps@everettwa gov I www.everettwa_govipermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1 1 1 8 80TH ST SW PROPERTY TAX#: 00392200001700 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No- (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: BOTTLING GROUP LLC TENANT NAME(If Commercial): New Cingular Wireless, LLC. <br /> OWNER MAILING ADDRESS: STEET PO BOX 660634 <br /> DALLAW STAT_ TX z:P 75266 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: T.B.D. OUT TO BID - Will be provided by/at time of BP issuance <br /> CONTRACTOR ADDRESS: STREET <br /> CIT! STAT Zip <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REULIIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ,1 OTHER(Please SpeciN) Authorized Agent <br /> CONTACT NAME: CONTACT PHONE: Q: 206-523-1941 / M: 206-949-3321 <br /> Chris DeVoist CONTACT EMAIL: cdevoist@rykaeonsulting.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building Unmanned'Wireless Communications Facility Contract Price of Work:$20,000 <br /> Proposed Use of Building Unmanned Wireless Communications Facility Heat Source: ❑Gas ❑Electric []Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Rlulti-Family-#of Units ❑Conmiercial ❑Industrial <br /> Type of Project ❑New ❑Addition ORenlodel ❑Repair ❑TI ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: AT&T proposes to replace(3) existing antennas with (3)replacement antennas and (3) <br /> small remote radio units, with (3) replacement units,at an existing rooftop wireless facility. <br /> ASSOCIATED BUILDING PERMIT#(rf applicable) <br /> MECHANICAL PERMIT APPLICATION NIR PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn Alteration Repa Type of Project: New Addn Alteration Repair <br /> #of #of #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> XC-Air Handling Units Heat Pump Toilet 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 Drver Hookups Other Clothes Washer Medical Gas <br /> Range Hood Water Heater Other <br /> Exhaust Fan Sink(ServicelBar.*Iop.ietc) Other <br /> SPRINKLER I SUPPRESSION-SYSTEM <br /> Number of Heads N/A <br /> ACKNOWLEDGEMENT f nave 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 focal 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. t am the owner,or 1 air,authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with tne.date Contractors Law 18.27 RCW and 296.200A WRC <br /> i <br /> City of Everett Official Use Only <br /> / PERM! b <br /> OwnerlAuthorized Agent Signature Date (Revised 9/ 312016) <br />