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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING I SIGN /SPRINKLER/DEMOLITION <br /> Al6//4Pf:---4 CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 (E)everetteps@everettwa.gov t www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:309 E Casino Road PROPERTY TAX#: 00598700000101 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: BJJ Investments LLC TENANT NAME(If Commercial):Verizon <br /> OWNER MAILING ADDRESS: STREET 8380 SE 43rd St. <br /> CITY Mercer Island STATE WA ZIP 98040 <br /> OWNER PHONE: (206)697-I332 OWNER EMAIL: <br /> CONTRACTOR NAME: TBD ( UI hp <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE P _r./� <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: 1►( )Vv �_ <br /> CONTRACTOR LICENSE#(REQUIRED): j /F TJ 3 0 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):D ), 1 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ®OTHER(Please Specify) Verizon Authorized Representative <br /> CONTACT NAME: John Eder,J4 Site Solutions Inc,as CONTACT PHONE: 253-278-2902 <br /> Authorized Representative of Verizon CONTACT EMAIL: john@j4sitesolutions.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Multi-tenant retail,rooftop wireless 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 ODuplex ❑Multi-Family-#of Units: LNCommercial ❑Industrial <br /> Type of Project: E3 New ®Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: On the rooftop,remove(9)of the existing(12)antennas and add(6)new antennas for a new(reduced)total of(9) <br /> antennas,replace(3)remote radio heads and add(6)new remote radio heads for a new total of(9),replace(2)surge <br /> protection units,and add(2)hybrid cables.At the ground equipment,add(1)surge protection unit. <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 List of Fixtures #of List of Fixtures #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—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 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 /> Buildin.Official.efore being authorized under any circumstance.I am the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> • comply with e State Contractors Law 18.27 RCW and 296,200A WAC. <br /> City of Everett Official Use Only <br /> _/ <br /> ' AC. - PERMIT# <br /> John d- J4 Site Solutions Inc,as Authorized Representative •f er zon <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) 1 <br />