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41E-17- 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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 6107 Berkshire Dr.,Everett,WA 98203 PROPERTY TAX#: 28050600400900 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) See Construction Drawings <br /> CONTACT INFORMATION <br /> OWNER NAME: City of Everett TENANT NAME(If Commercial): T-Mobile <br /> OWNER MAILING ADDRESS: STREET 3002 Wetmore Ave <br /> CITY Everett STATE WA ZIP 98201 <br /> OWNER PHONE: �^ OWNER EMAIL: <br /> CONTRACTOR NAME: SL 'C W Iy.,(� <br /> IQ� <br /> CONTRACTOR ADDRESS: STREET ' <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: /� i�`J{CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): W�W Le,5 2 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 65.24S1 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 12110THER(Please Specify) Authorized Agent <br /> CONTACT NAME: CONTACT PHONE: 206-336-3204 <br /> Sarah Baird, Crown Castle,on behalf of T-Mobile CONTACT EMAIL: <br /> sarah.baird@crowncastle.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Existing Wireless Communications Facility Contract Price of Work:$ 75,000 <br /> Proposed Use of Building: No change Heat Source: EGas DElectric DOther <br /> Building Type: DSFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: E'Commercial ❑Industrial <br /> Type of Project: ❑New VAddition ❑Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: T-Mobile proposes to structurally reinforce monopole shaft;remove(1)platform mount,(3)antennas,(9)RRU's,(6) <br /> diplexers;and install(1)platform mount,(3)antennas,and(6)RRU's on existing tower.T-Mobile also proposes to replace(1) <br /> cabinet,remove(4)modules,and install(8)modules within cabinets within existing compound. <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 #of List of Fixtures List of Fixtures #°f List of Fixtures #°f 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/ SUPPRESSION SYSTEM <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 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 /> ��• I 10/31/2018 PEP \ \ —02}A <br /> O Authorized Ag-Tia.nature Date (Revised 9/23/2016) <br />