Laserfiche WebLink
#A11,-A <br /> BUILDIN( ECHANICAL I PLUMBINGPERMITAPPLIC <br /> /SIGNATION I me' <br /> RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 9910 Evergreen Way,98204 PROPERTY TAX#: 28041300302700 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION. . <br /> OWNER NAME: Deloris M Robinson/William D Tackitt TENANT NAME(If Commercial): Sprint <br /> OWNER MAILING ADDRESS: s7REET18960 SR 2#145/5917 Evergreen Way <br /> cin• Monroe/Everett STATE WA zip 98272/98203 <br /> OWNER PHONE: OWNER EMAIL:/ <br /> CONTRACTOR NAME: vG fjJ <br /> ; / <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):' '2 `r- ' <br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR Ea OTHER(Please Specify) Smartlink LLC on behalf of Sprint <br /> CONTACT NAME: Nancy Sears CONTACT PHONE: 425.444.1434 <br /> CONTACT EMAIL: nancy.sears@smartlinklIc.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: SnoPUD Utility Pole41-1941-fied Contract Price of Work:$ 20,000 <br /> Proposed Use of Building: n/a Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached CI SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ElCommercial ❑Industrial <br /> Type of.Project: ONew ❑Addition ®Remodel El Repair- CIT. . El Sign ❑Sprinkler El Demolition CIChange of Use <br /> DESCRIPTION OF WORK: Modification to existing wireless communications facility on SnoPUD utility pole-Remove and 6 antennas,install <br /> antennas,6 remote radio units(RRUs)and 3 filters, <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 #of List of Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <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.: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 work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.1 am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 116PC7(O ._6) V2___. <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />