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PERMIT APPLICATIOm <br /> #.144kr—/ A BUILDING /MECHANICAL/PLUMBING/SIGN I SPRINKLER I 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:5828 Glenwood Ave 'PROPERTY TAX#: 28040100201200 <br /> LEGAL for new construction: Short Plat/subdivision Lot No_ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: PUD Dist 1 -Snohomish County(SnoPUD)TENANT NAME(If Commercial): New Cingular Wireless, LLC. <br /> OWNER MAILING ADDRESS: sTrtEEr 2320 California <br /> CITY Everett STATE WA zip 98201 <br /> OWNER PHONE: 'OWNER EMAiL: <br /> CONTRACTOR NAM . . .G. ' : G - • •— • r : : • _ " • - l`)[/YIY ill Allot I Te1 <br /> CONTRACTOR ADDRESS: STREET v <br /> CRY STATE ZIP <br /> CONTRACTOR PHONE: 'CONTRACTOR EMAIL: �/� <br /> CONTRACTOR LICENSE#(REQUIRED):claim-L-121 GCj Icrry OF EVERETT BUSINESS LICENSE#(REQUIRED): 0`J 4€ i 1p2 <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ,R]OTHER(Please Specify)Authorized Agent <br /> CONTACT NAME: CONTACT PHONE: 0:206-523-1941 /M: 206-949-3321 <br /> Chris DeVoist CONTACT EMAIL:cdevoist@rykaconsulting.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Unmanned Wireless Communications Facility Contract Price of Work:$90,000 <br /> Proposed Use of Building:Unmanned Wireless Communications Facility Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached OSFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project ❑New ❑Addition 2lRemodel ❑Repair OT.I_ ❑Sign ❑Sprinkler ['Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: AT&T proposes to remove an existing 113'-2"high utility pole and antennas,and replace <br /> with a new 113'-2"high steel utility pole with(6)new panel antennas and new and <br /> relocated associated equipment and cabling. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION;IN/A I PLUMBING PERMIT APPLICATION <br /> Type of Project: New _ Addn _Alteration_RspAT 1 Type of Project: _New Addn =Alteration _Repair N/AL, <br /> Fixtures List of Fixtures Fixtures of Fixtures Fixtures list of Fixtures FixturesList of Fixtures <br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidq) <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(Sennce/Bar/Map/etc.) Other: <br /> SPRINKLER/SUPPRESSIOIIt.; TEM <br /> 'Number of Heads INA <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.lam 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 /> jPERMIT#151.t42t o— b <br /> Owner/A • Agent Signature Date (Revised 5/23/2016) ; `._ <br />