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• � <br /> PERMIT APPLICATION <br /> BUILDING 1 MECHANICAL / PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVBCES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.evereriwa.gov/permits <br /> (Biue or Black Ink Only Please) PR�JECT SITE INFORMATION <br /> PROJECT5ITEADDRESS:4J�12 FOREST DRIVE PROPERTYTAX#: 0044�4OOZOO9OO <br /> LEGAL for new construction. Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: OUR SAVIOR'S LUTHERN CHURCH OF EVERETT TENANT NAME(If Commercial): NeW CIflgUlef WlfeleSS, LLC. <br /> OWNER MAILING ADDRESS: s-nzeeT 4512 FOREST DRIVE <br /> �,�Y Everett STA�WA Z�P 98213 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME `•-�j�„1„ ". 'L-tY�+-._(� �, <br /> CONTRACTOR ADDRESS: sTne� <br /> CITV STATE 21P <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CffY OF EVERETT BUSINESS LICENSE#(REQU ED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ,�OTHER(PEease Spe�ify) AUthol'IZed Agent <br /> CONTACT NAME: CONTACT PHQNE: Q: 206-523-1941 /�: 205-949-3321 <br /> Chris DeVoist coNTACT EMai�:cdevoist@rykaconsufting.com <br /> BUILDING PERMiT APPLICATION <br /> Existing Use of Building: Unmanned Wireless Communications Facility Contract Price of Work:$90,�Q� <br /> Proposed Use of Building:Unmanned Wireless Communications Facility Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑11�1u1ti-Family-#of Units: OCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition �Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demalitlon ❑Change of Use <br /> DESCRIPTION OF WORK: AT&T proposes to remove an existing 52'-5"high utility pole and antennas,and replace <br /> with a new 70'-0"' high steef utility pobe with(6) new panel antennas and new and <br /> relocated associated equipment and cabling. <br /> ASSOCIATED BUfLDING PERMIT#(�f applieable}: <br /> MECHANICAL PERMIT APPLICATION ��a PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Aheration _Repa Type of Project: _New Addn Akeratan _Repair N/A <br /> M of Lis!of Fixtures #of List o/Fixtures ��f List of Fixtures #of Vst of Fixtures <br /> Ffxiures F��[tures Fixtares Fixtures <br /> A�`C—Air Handli Units Heat Pum ToiEet BackfEow Preventer Inside Bld <br /> Forced Air Systems Unii Heater BathTub llrinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Qrain <br /> Gas Ffreplace Wood Stove Kitchen Sink 8 Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other Giothes Washer A�edical Gas <br /> Range Hoad WateF HeaFer �ther: <br /> F�chaust Fan Sink(Servicet6adR�topletc.) Other: <br /> SPRINKLER 1 SUPPRESSIO TEM <br /> Number of Heads ��R <br /> ACKNOWtEDGEMENT:!nave reviewed this applrcatron and conlrrm the informatron contained herein is true and correct.Work done pursuant to tRrs permit must compfy with <br /> current/ederal,siste,and Iocaf law. The granting ot a permit only authonzes approveQ work and no deviations therefrorn.Deviations must fiest be au[horfzed in writing from tne <br /> 8uilUing 01�ic�al Detore berng author¢ed urrder any arcumstance.f am the ouvner,or I am autflorized by tne owner ot Ch�s prope�ty to peNorm Ehe work ior wrirch applicatron is made, <br /> anQ I compfy wrt�lie�St3te Contractors Law t8.27 RCW and 296.200A WAC. <br /> / _ — Ciry ot Everett Ol(icraf Use Only <br /> PER ` O <br /> 1� Z� � �" , <br /> Ownerl uthorized Age �grwture Date (Revised 2/"132076} <br /> � �, M <br />