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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 Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2420 39th St. Everett, WA 98201 PROPERTY TAX#: 00576003200011 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ack Sheeler TENANT NAME(If Commercial): CTOWri CaStle USA <br /> OWNER MAILING ADDRESS: srReeT 8919 Eastview Ave <br /> cirv Everett sTnre WA ziP 98208 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: V�S �'(� 1/v <br /> CONTRACTOR ADDRESS: srReeT <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)� O <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR �OTHER(Please Specify) A ent 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 /> Existing Use of Building: Unmanned telecommunications facility Contract Price of W rk $ <br /> Proposed Use of Building: Unmanned telecommunications facilit Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel �Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Replace (2) FXFB with (3) FHFB. Move (1) FXFB inside cabinet. Add (1) FSMF for L19. Replace (1) FSME with (1) <br /> FSME for U 19. <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 _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #°� List of Fixtures <br /> Fixtures Fintures 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:1 have reviewed this application and confirm the information contained herein is true and conect. 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 Officia/before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which app/ication 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 C� r� <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> L1� <br />