1927 W MUKILTEO BLVD CINGULAR WIRELESS ANTENNA 2019-02-20

477- PERMIT APPLICATION BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 i FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 1927 W Mukelteo Blvd PROPERTY TAX#: 0041 71 00004701 LEGAL for new construction: Short Plat/subdivision See A-1 Sheet Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Edwin Todd Chase TENANT NAME(If Commercial): New Cingular Wireless, LLC. OWNER MAILING ADDRESS: STREET 1927 W Mukilteo Blvd CITY Everett STATE WA ZIP 98203 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: General Dynamics Info Tech CONTRACTOR ADDRESS: STREET 19240 Des Moines Memorial Drive South Suite 300 CITY SeaTac STATE WA ZIP 98148 CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): GENERDI927CG CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):054962 PRIMARY CONTACT: 0 OWNER ❑ CONTRACTOR ZI OTHER(Please Specify) Authorized Agent CONTACT NAME: CONTACT PHONE: 0: 206-523-1941 / M: 425.351.3392 Christine Contreras, on behalf of AT&T CONTACT EMAIL: ccontrerast@rykaconsulting.com BUILDING PERMIT APPLICATION Existing Use of Building: Unmanned Wireless Communications Facility Contract Price of Work:$20,000 Proposed Use of Building: Unmanned Wireless Communications Facility Heat Source: DGas ❑Electric ❑Other Building Type: DSFR-Detached DSFR-Attached ❑Duplex DMulti-Family-#of Units: _ ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition ElRemodel ❑Repair DTA. DSign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: AT&T is proposing to swap two existing antennas and replace four TMA units on existing pole. No v�J increase in height or ground disturbance. ASSOCIATED BUILDING PERMIT#(if applicable): B1615-052 MECHANICAL PERMIT APPLICATION IN/A PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn Alteration Repalft 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 NC—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/SUPPRESSIO TEM (Number of Heads N/A 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 I am authorized by the owner of this property to perform the work for which application is made, and I comply with tote State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only � �..: , PERMITS# / roe- 09 Owner/ uthorized Agent Signature /Date ) ir� (Revised 9/23/2016)