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grr 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 t FAX 425-257-8857 t(E)everetteps@everettwa.gov( www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1871 Ross Ave PROPERTY TAX#: 29050900300100 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Dagmars Marina LLC(Verizon owns the cell tower)TENANT NAME(If Commercial):Verizon <br /> OWNER MAILING ADDRESS: STREET 1871 Ross Ave <br /> -- " CITY Everett STATE WA ZIP 98201 <br /> OE: 425 V 59-6124 /] �, _y,, OWNER EMAIL: dagmarsmarina@integra.net <br /> O RACTOR N• E: TBD e I(JAI e 5o�c - SLS <br /> ITRAC. e -ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE. - �y CONTRACTOR EMAIL: z. <br /> CONTRACTOR LICEN #(REQUIRED): i c P�/ 5. 8$3 )3 CITY OF EVERETT BUSINESS LICE E#(REQUIRED): 1 p'.. •Ge <br /> PRIMARY CONTACT: ■ "e•• ; 0 CONTRACTOR I&OTHER(Please Specify) Verizon Authorized Repre - •- <br /> CONTACT NAME: John Eder,J4 Site Solutions Inc,as CONTACT PHONE: 253-278-2902 <br /> Authorized Representative of Verizon CONTACT EMAiL: john@j4sites i o . om <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Wireless Telecommunication Facility Contract Price of Work: 15 000 <br /> Proposed Use of Building: No change Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ,'Commercial ❑Industrial <br /> Type of Project: ❑New ®Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler 0 Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: At the top of the existing 150'stealth flagpole tower,and inside the concealed canisters,replace all(6)panel <br /> antennas,add(6)diplexer units,and add(6)small filter units.At the ground equipment,replace ancillary <br /> equipment inside the existing equipment building. <br /> ASSOCIATED BUILDING PERMIT#(if applicable):N/A <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New — Addn Alteration _Repair Type of Project: New Addn _Alteration _Repair <br /> #of #°f List of Fixtures List of Fixtures #of List of Fixtures #°f 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 1 SUPPRESSION SYSTEM <br /> Chemical or Water I INo.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.I am the owner,or tam authorized by the owner of this property to perform the work for which application is made, <br /> and I with the State Contractors Law 8.27 RCW and 296.200A WAC. <br /> q//..*, 7— <br /> City of Everett Official Use Only <br /> PE T# ' 2 <br /> Jo ,J4 Site Solutions Inc,as Authorized Representative of Verizon ` t — J <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) / <br />