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SE54XC102 <br /> OLT 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 1 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: 6515 Morgan Rd, Everett 98203 PROPERTY TAX#: 00393400002400 <br /> LEGAL for new construction: Short Plat/subdivision 6 Lot No. 24&25(attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: South Everett Lions Club TENANT NAME(If Commercial): Sprint <br /> OWNER MAILING ADDRESS: STREET PO Box 1404 <br /> c, Marysville STATE WA ZIP 98270 <br /> OWNER PHONE: 206.528.2625 OWNER EMAIL: <br /> CONTRACTOR NAME(1: r(..` - sc (t C y� �" A L -- <br /> CONTRACTOR ADDRES STREET <br /> ! I <br /> CITY VA11CoaiYier STATE u..94 ZIP <br /> CONTRACTOR PHONE: n CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): tO(2`1 SC ig ) t cLk CITY OF EVERETT BUSINESS LICENSE#(REQUI(kg..1Z)::46t0 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ® OTHER(Please Specify) Smartlink LLC on behalf of Sprint <br /> CONTACT NAME: Nancy Sears CONTACT PHONE: 425.444.1434 <br /> CONTACT EMAIL: nancy.sears@smartlinkllc.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: SnoPUD Utility Pole in ball field Contract Price of Work:$ 20,000 <br /> Proposed Use of Building: n/a 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 ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Modification to existing wireless communications facility on SnoPUD utility pole-Remove and replace 3 antennas, <br /> install 6 remote radio units(RRUs) and 3 filters, remove existing collar mount and replace with chain mount. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): Previous BP#61301-028 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration Repair Type of Project: _New Addn _Alteration _Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> 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 I 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.I am the owner,or I 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 Official Use Only <br /> )1 �c 6f PERMIT <br /> �� /� ( - 02 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />