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� <br />• • <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />ADDRESS: <br />Walnut Street Everett, WA 98201 <br />for new construction: Short PlaUsubdiv <br />Snohomish County PUD <br />PO Box 1107 <br />see attached <br />PROPERTY TAX # <br />00556340601701 <br />Lot No._ <br />Phone/E-mail <br /># <br />(attach copy of long legal description) <br />City/State/Zip Everett, WA 98206 <br />� <br />Owner _ Owner'S A92nt _ COntfBCtOf _ COntfaCfof'S Ageflt � T0f18f1t (must provide a letter of consent from the owner to do work in the <br />CONTRACTOR TB� State Lic. # City Bus. Lic. # <br />Address Phone/Email <br />TENANT BUSINESS NAME CONTACT FOR PERMIT Colin Robinson <br />T-Mobile 425-533-2665 <br />Phone/E-mail colin.robinson@cascadiapm.com <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK $20,000 <br />Existing Use of Building Wireless Communications Facility HEAT SOURCE: n/a <br />Proposed Use of Building W�reless Communications Facility Gas Electric Other_ <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition �Remodel Repair T.I. Si n Sprinkler Demolition Chanqe of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : Modification to existing wireless site. On pole: remove 3 panel antennas, <br />remove 3 TMAs, add 3 new panel antennas and add 3 new RRUs. On ground: decommission U2100 <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number # of �xtures <br />A/C — air handlin units <br />Forced air s stems <br />Gas i in <br />Water heater <br />Gas fire lace <br />Gas ran e <br />Clothes d er <br />Ran e hood <br />Exhaustfan <br />Heat um <br />Unit heater <br />Boiler <br />Refri eration <br />Woodstove <br />Ductin <br />Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of �ntures <br />Toilet <br />Bathtub <br />Lavatorv (wash basin) <br />Kitchen sink & dis <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/i <br />Backflow preventE <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby certify that I have read and examined this application and know the same to be hue and correct. All provisions of laws and ordinances governing this type of work will be comp <br />wdh whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br />That I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />� l�� � ��_ 8-11-2015 <br />Owner/Authorized Agent Signature Date (Revised 4/2015) �� <br />