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PERMIT APPLICATION <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER i DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-267-8810 1 FAX AIMIA7-PA47 r re► _-.. I .-----------_-- <br />- ---- ---• �a-r...,..o..o,.o.�,a....a•y.,�1 www.evereawa.govrpevnns <br />Blue .or Black Ink On Plow PRO.IECT ai1TE 110,01k �ATiON , <br />PROJECT SITE ADDRESS: 1321 COiby Ave. PROPERTY TAX #. 00438524600000 <br />LEGAL for new cons(ruction: Short Plat/subdivislon Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: Providence Health & Services Washington TENANT NAME (If Commercial): T-Mobile <br />OWNER MAILING ADDRESS: STREET 1801 Lind Ave SW #9016 <br />crry Renton STATE WA aP 98057 <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAMES LL,,M4 VIA rl t lV , <br />CONTRACTOR ADDRESS: STREET <br />CRY STATE ZIP <br />CONTRACTOR PHONE: <br />CON EMAIL: <br />ONTRACTOR LICENSE #(REQU ):f <br />CI F EVERETT BUSINESS LICENSE #(RE D): In 0 <br />PRIMARY CONTACT: ❑ OWNER TOR PIOTHER (Please Specify) 7LLC- agent of T-Mobile <br />CONTACT NAME: <br />Brent Sutten <br />CONTACT PHONE: 301-752-9750 <br />ICONTACT EMAIL: bsuttell m <br />BUILDING `°iIPERMIT.APPLlCAT10 <br />Existing Use of Building: Unmanned Rooftop Telecommunications Facir1 <br />Contract Price of ark: s 10,00() <br />Proposed Use of Builds : Unmanned Rooftop Telecommunications Fadl' <br />Heat Source: Gas ❑Electr❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Fami -# of U its: Commercial ❑Industrial <br />Igo of Project ❑New ❑Addition ❑Remodel 1ARepair ❑T.I. ❑Sin ❑Sprinkler ❑Demolition OChange of Use <br />DESCRIPTION OF WORK: <br />Remove: (3) FXFCS RRUs, (2) Ultresite Cabinets, (1) ESMB, (1) FSMF, (1) FBBCS; Add: (3) FHFB, (1) ASIA, (2) ABIA, (1) AMOS, (1) FCOA Cabinet <br />ASSOCIATED BUILDING PERMIT # if applicable): <br />MINCHAIICAL"iPlRMIT�APP <br />'PiL - AWN, woERMIT:APPI rC%CTi�N` <br />Type of Project: _New Addn Alteration _Repair <br />Type of Project: —New_ Addn Alteration _Repair <br />Fn# of <br />List of Hxtures <br />Fix u f <br />List of Fixtures <br /># of <br />Fbdur" <br />List of Fhrtares <br /># of <br />Fixtures <br />tlst of Fbdwvs <br />A(C -Air HandlingUnits <br />Forced Air Systems <br />Heat Pump <br />Unit Heater <br />Toilet <br />Bathtub <br />Backflow Preventer Inside Bldg) <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory Wash Basin <br />Drinking Fountain <br />Water Heater <br />Refteration <br />Shower <br />I Floor Drain <br />Gas Fireplace <br />Wood Stove <br />Kitchen Sink & Disposal <br />lGrease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hooku <br />Other: <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />Water Heater <br />Other; <br />Exhaust Fan <br />Sink Service/Bar/Mo etc <br />Other: <br />3011dNKLERT8_ <br />PPRES$ION SYBTEfl1 <br />Chemical or Water <br />No. of Heads <br />xaaurV vrL=EA=Mery r: i nave revrewea vas BAN=trCrt ono canarn the lnfonnaUon contained herein fs irw and correct. Work done pursuant to this pwow must comply with <br />current federal, state, and Wallqw. The granting of a pw w only authorizes approved work and no dsvfad" therefrom. Deviedans must /first be authorised in writing from the <br />BuAft Oftlat before being euthorked under any circumstance. I ern the owner, or l am sudw&ed by the owner of this property to perform the work for whlah appficaffan is made <br />SW t comply with the State Contractors Law 18 27RCW and 296.2004 WAC. <br />City of Everatt 011kW Use <br />PERMI \ <br />