2215 MERRILL CREEK PKY VERIZON WIRELESS ANTENNA 2018-06-07

PERMIT APPLICATION 4"-/- BUILDING 1 MECHANICAL/PLUMBING 1 SIGN /SPRINKLER/DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 t FAX 425-257-8857 ((E)everetteps©everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS:2215 Merrill Creek Parkway,Everett,WA _PROPERTY TAX#: 28040200300300 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Polo Properties LLC(Crown Castle owns the tower)TENANT NAME(If Commercial): Verizon OWNER MAILING ADDRESS: STREET 3248 Hunts Point Rd.,Bellevue,WA 98004 CITY Bellevue STATE WA ZIP 98004-1126 OWNER PHONE: Unknown OWNER EMAIL: Unknown CONTRACTOR NAME:,�'$j3 CAC. D (xx- CONTRACTOR ADDRESS: STREET , 02j,0 2L Quj J C J CITY (OLCe STATE ( OA; ZIP -l�3 CONTRACTOR PHONE: CONTRACTOR EMAIL: VVV"�� �lL °LSC) ( �0 D CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRE, ): At PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 13 OTHER(Please Specify) Verizon Authorized Representative It"— CONTACT NAME: John Eder,J4 Site Solutions,Inc.as CONTACT PHONE: 253-278-2902 Authorized Representative of Verizon CONTACT EMAIL: john@j4sitesolutions.com BUILDING PERMIT APPLICATION Existing Use of Building: Wireless Telecommunication Facility Contract Price of Wor :$ 15,000 Proposed Use of Building: No change Heat Source: ❑Gas ❑Electr ❑Other Building Type: ❑SFR-Detached ❑SFR Attached ❑Duplex ❑Multi-Family-#of Units: LICommercial ❑industrial Type of Project: ❑New ®Addition ❑Rem odel ❑Repair ❑T.I. ❑Sign OSprinkler ODemolition ❑Change of Use DESCRIPTION OF WORK: On the existing 150'tower at 95',replace all(6)panel antennas,replace(3)remote radio heads,add(3)new remote remote radio heads,and add(6)coaxial cables.At the existing fenced ground equipment,add(6)remote radio heads and(6)diplexers. ASSOCIATED BUILDING PERMIT#(if applicable):N/A MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn Alteration _Repair Type of Project: _New _Addn _Alteration _Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER 1 SUPPRESSION SYSTEM Chemical or Water No.of Heads 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 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 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, and/c•„: ith the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only i e-144(//7-- PERMIT# Joh,it r,J4 Site Solutions,Inc as Authorized Representative of Verizon 1 7 04- t q Owner/Authorized Agent Signature Date (Revised 9/23/2016) I`R e