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"IPPERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> 14'f CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I 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:2020 Lake Heights Drive PROPERTY TAX#: ROW adjacent to 28052900202400 <br /> LEGAL for new construction: Short Flat/subdivision see legal sheet T1 dwgs Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Public Utility Dist 1 Sn0 Co (SnoPud) TENANT NAME(If Commercial): New Cingular Wireless PCS, LLC. <br /> OWNER MAILING ADDRESS: STREET PO Box 1107 <br /> CITY Everett STATE WA ZIP 98206 <br /> OWNER PHONE: 425-783-1000 (OWNER EMAIL: MMNave@SNOPUD.com <br /> CONTRACTOR NAME: General Dynamics Info Tech <br /> CONTRACTOR ADDRESS: STREET 19240 Des Moines Memorial Drive South Suite 300 <br /> cmi' SeaTac STATE WA zip 98148 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): GENERDI927CG CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):054962 <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR in OTHER(Please Specify)Authorized Agent <br /> CONTACT NAME: CONTACT PHONE: 0:206-523-1941 /M:425.351.3392 <br /> Christine Contreras on behalf of AT&T CONTACT EMAIL:ccontreras©rykaconsulting.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Unmanned Wireless Communications Facility Contract Price of Work:$20 000.00 <br /> Proposed Use of Building:Unmanned Wireless Communications Facility Heat Source: ❑Gas DElectric ❑Other N/A <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ['Duplex 0 Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew ['Addition (Remodel ❑Repair ❑T.I. DSign ['Sprinkler ['Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> AT&T is proposing to replace three existing antennas and install six TMA units on existing SnoPud <br /> Utility pole located in the ROW. All Pole work to be preformed by Snohomish County PUD. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): BI605-051 <br /> MECHANICAL PERMIT APPLiCATiONIN/A I PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn _Alteration Repair Type of Project: _New Addn _Alteration _Repair N/A L <br /> #of #°f List of Fixtures List of Fixtures #of 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 I SUPPRESSIOTEM <br /> (Number of Heads N/A <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 wit,i-- a: .ntractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> i/(5 A 0 <br /> U PEriF#1R0(0 — aUCZ <br /> Owneriktfraiied Agent Signa Date (Revised 9/23/2016) <br /> 1 <br /> 0 � <br />