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0 • <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL 1 PLUMBING / SIGN /SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa-gov I www everettwa.govlpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 906 SE Everett Mall Way PROPERTY TAX#: 2805518003085500 <br /> LEGAL for new construction: Short Plat/subdivision Lot No_ (attach copy of long legal descnption) <br /> CONTACT INFORMATION <br /> OWNER NAME: Plueger-Everett Holdings, LLC. TENANT NAME(If Commercial): New Cingular Wireless, LLC. <br /> OWNER MAILING ADDRESS: STREET 601 Union Street#3500 <br /> c,Tr Seattle STATE WA ZAP 98101 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: - V I e provided y/at ti <br /> CONTRACTOR ADDRESS: STREET Cj Y l� <br /> C m' STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ZI OTHER(Please Specify) Authorized Agent <br /> CONTACT NAME: CONTACT PHONE: Q: 206-523-1941 / M: 206-949-3321 <br /> Chris DeVoist CONTACT EMAIL: cdevoist@rykaCOnsulting.COm <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Unmanned Wireless Communications Facility Contract Price of Work:$ 15,000 <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= ❑Commercial ❑Industrial <br /> Type of Project ❑New ❑Addition ORemodel ❑Repair [IT-1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: AT&T proposes to replace(3) existing small remote radio units, with (3) replacement units, <br /> along with new equipment cabinet,at an existing,rooftop wireless facility, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION lid/A PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn Alteration Re, Type of Project: New Addn Alteration Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> A,C—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 Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other <br /> Exhaust Fan Sink(Service'Bar/MoWetc) Other: <br /> SPRINKLER/SUPPRESSIO TEM <br /> Number of Heads NIA <br /> 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 <br /> 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 <br /> Building 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 th77' <br /> State tractors Law 18.27 RCW and 296.200A WAC <br /> City of Everett Official Use Only <br /> PERMIT <br /> Owner/Authorizes ed Agent Signature Date (Revised 912312016) <br /> Vi j�� <br />