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• PERMIT APPLICATIO� <br /> BUILDING / MECHANICAL / PLUMBING / SIGN /SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or Black Ink Oniy Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �lO N BOYaC�Wd Everett,WA 98201 PROPERTY TAX#: 00497100005900 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Whido Isle LLC TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReeT P.O. Box 448 <br /> c�rr Everett STATE WA z�P 98201 <br /> OWNER PHONE: O R EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: sTREET <br /> CITV STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: - � <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUI ED): O <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR �OTHER(Please Specify) Representative for T-Mobile <br /> CONTACT NAME: CONTACT PHONE: g58-964-7430 <br /> Kathleen Doan-Ha CONTACT EMAIL: kdoanha@md7.com <br /> BUILDING PERMIT APPLICATION <br /> Existin Use of Building: Unmanne telecomm nications facilit Contract Price of rk: $ 25,000 <br /> Proposed Use of Building[Jnmanned telecommunications facility Heat Source: ❑ as ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Un : Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel �Repair ❑T.I. ❑Sign ❑Sprinkler emolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Replace existing(6) TMAs with (3) style 3C TMA, remove(2) FXFB,and add(3) FHFBs behind antennas <br /> ASSOCIATED BUILDING PERMIT# if applicable : <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration Repair Type of Project: _New _Addn Aiteration Repair <br /> #of Lisf of Fiutures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fi�ctures <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/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this app/ication 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 aufhorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> , _. --� . J�Z�/I1 PE�1� �OO � <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> �� , <br />