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� III PERMIT APPLICATIO
<br /> BUILDING�IECHANICAL/ PLUMBING /SIGN�RINKLER/ 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: 6107 Berkshire Dr.,Everett,WA98203 PROPERTY TAX#: 2g0506-004-009-00
<br /> LEGAL for new construction: Short PlaUsubdivision See attached property report Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: Ci of Everett TENANT NAME(If Commercial): Tower O erator-Crown Castle
<br /> OWNER MAILING ADDRESS: STREET 2930 Wetmore Ave
<br /> cirv Everett STATE WA ziP 98201
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: TSD
<br /> CONTRACTOR ADDRESS: srReer
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#�REQUIRED):
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<br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR �OTHER(Please Specify) Authorized A�ent
<br /> CONTACT NAME: CONTACT PHONE: 206-336-3204
<br /> Sarah Baird,Crown Castle,on behalf of T-Mobile CONTACT EMAIL: sarah.baird@crowncastle.com
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<br /> Existin Use of Buildin : Wireless Facili Contract Price of Work:$ 5,000
<br /> Proposed Use of Buildin : N/A Heat Source: ❑Gas ❑Electric ❑Other
<br /> Buildin T e: ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famil -#of Units: �Commercial ❑Industrial
<br /> T pe of Pro'ect: ❑New �Addition ❑Remodel ❑Re air ❑T.I. ❑Si n ❑S rinkler ❑Demolition ❑Chan e of Use
<br /> DESCRIPTION OF WORK:
<br /> T-Mobile proposes to install(1)APU 48VDC Generator 7.SKW and(1)ASME 120 gallon LP tank w/fill valve with integral
<br /> manual shutoff valve.
<br /> ASSOCIATED BUILDING PERMIT# if a licable :
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<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 ��st of Fixtures #of List of Fixtures
<br /> Fi�rtures Fixtures Fixtures Fixtures
<br /> A/C—Air Handlin Units Heat Pump Toilet Backflow Preventer(Inside Bld
<br /> Forced Air S stems Unit Heater Bathtub Urinal
<br /> i Gas Pi in Boiler Lavato Wash Basin Drinkin fountain
<br /> Water Heater Refri eration Shower Floor Drain
<br /> Gas Fire lace Wood Stove Kitchen Sink&Dis osal Grease Tra
<br /> Gas Ran e Ductin Dishwasher Roof Drains
<br /> Clothes D er Hooku s 1 Oth@f:PropaneTank Clothes Washer Medical Gas
<br /> Ran e Hood Water Heater Other:
<br /> Exhaust Fan Sink Seroice/Bar/Mo /etc. Other:
<br /> 3�i A t.�� %'<3,
<br /> Chemical or Water No.of Heads
<br /> ACKNOWLEDGEMENT.•1 have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comp/y with
<br /> current federal,state,and focal law. The granting of a permit on/y authorizes approved woric 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/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 O�cial Use Only
<br /> PERMIT#
<br /> � � 12/6/2017 Ir �/s� _�G'� 1 � �
<br /> wner/Authorized A t ignature Date (Revised 9/23/2016)
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