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- (' _ <br /> 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 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) - PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 9610 19th Ave SE PROPERTY TAX#: 28051800406500 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Premier Storage Everett LLC TENANT NAME(If Commercial): Verizon Wireless <br /> OWNER MAILING ADDRESS: STREET 5729 Lakeview Dr NE. Ste 200 <br /> CITY Kirkland STATE WA zip 98033 <br /> OWNER PHONE: N/A OWNER EMAIL: N/A <br /> CONTRACTOR NAME: \ '40/VOA `-� <br /> e.--C_CJvv\- <br /> CONTRACTOR ADDRESS: STREET iC(oC ), 77_v1( fvp 5 . -- <br /> CITY c r-.�\--1 STATE l " ZIP 9 ISC --5D <br /> CONTRACTOR PHONE: 8- G G C7 -\S 3 3 CONTRACTOR EMAIL: —5,\-lam Le'„tm."c17c''(7, () <br /> CONTRACTOR LICENSE#(REQUIRED): <MIej - _ D%i." CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)57 gg <br /> PRIMARY CONTACT: l".3OWNER 0 CONTRACTOR MI OTHER(Please Specify) Tenant Rep1agPnt <br /> CONTACT NAME: Les Cooley CONTACT PHONE: 425-530-2945 <br /> CONTACT EMAIL: lesAsage-hill.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Cell Tower Contract Price of Work:$ 15, 800.00 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: akommercial ❑Industrial <br /> Type of Project: CI New ❑Addition ❑Remodel CI Repair DTA. ❑Sign OSprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Remove 9 antennas and repalce with 9 new antenna, remove 3 RRU's and replace wit i <br /> 6 RRU's, remove 6 diplexers and replace with 6 new diplexers per plans. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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 #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures 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 I SUPPRESSION SYSTEIil1 <br /> Chemical or Water ' 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 authori -"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 w' a State Contr.; o'.Law 18 -CW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT <br /> 4 i 9/8/17 OP(7o?-0(d <br /> Owner/Auth i t Signature Date (Revised 9/23/2016) /�. <br /> J <br />