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PERMIT APPLICATION
<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
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<br /> PROJECT SITE ADDRESS:ZO9 EaSt CaSIC10 ROaCI PROPERTY TAX#: 00598700000�O�
<br /> LEGAL for new construction: Short PlaUsubdivision see leqal sheet A-1 dwqs lot No. (attach copy of long legal description)
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<br /> OWNER NAME: �aftg Ballg J8 TENANT NAME(If Commercial): N2w CI11gU181'WlfeleSS PCS, LLC.
<br /> OWNER MAILING ADDRESS: s�eer 8380 SE 43rd Street
<br /> �,n Mercer Island STATE WA Z,P 98040
<br /> OWNER PHONE: N/A OWNER EMAIL: N/A
<br /> coNTwacTOR N,anne: General Dynamics Info Tech
<br /> CONTRACTOR ADDRESS: sTReer 19240 Des Moines Memorial Drive South Suite 300
<br /> crrv SeaTac STATE WA ziP 98148
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): GENERDI9Z7CG CITY OF EVERETT BUSINESS LICENSE#(REQUI n�:054962
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<br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ,P�OTHER(Please Specify) r
<br /> CONTACT NAME: CONTACT PHONE: �: 2�6-523-'I94'I / M: 4Z5.35').3
<br /> Christine Contreras, Otl b@half Of AT&T coNTacT eM,ai�:ccontreras@rykaconsulting.com
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<br /> Existing Use of Buildin : Unmanned Wireless Communications Facility Contract Price of Work:$ !� ��
<br /> Proposed Use of Building: Unmanned Wireless Communications Facility Heat Source: ❑Gas ❑Electric ❑Other N/A
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition ORemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Chan e of Use
<br /> DESCRIPTION OF WORK:
<br /> �T&T` is proposin� to swap (6) panel antennas, add (6) RRH units, and (2} Surge �uppression units an
<br /> ��i��irr� roaftc�p facility: Additic�nally, AT&T wi�l add ancillary equipment inside their existing lease area.
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): B1601-039
<br /> MECHANICAL PER11�11�'APPLICA�IdW�...� NfA "; = � 3;�p�U1�I[BING PERMIT AFPLIGATION ,:"'..=
<br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair ���
<br /> Fixtures List of Fixfures Fi�rtu es List of Fixfures Fixtures Lisf of Fixtures Fixtu es List of Fixfures
<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 /> SPRIN�CL�R%'SUaP!R�S�I'C> � T�NI:: . �:;
<br /> Number of Heads N/A
<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 wonc and no deviations therefrom.Deviations must first be authorized in writing from the
<br /> Building O�cial before being authorized under any circumstance.1 am the owner,or 1 am authorized by the owner of this properly 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 /> PERMIT#
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<br /> wner/��rflTt�Agent Signature te (Revised 9/23/2016)
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