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/���—� ELECTRICAL PERMIT APPLICATION <br /> ^+' CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 ! FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> f. Z1 PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 1131 112TH ST SE <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: Cell Tower(Wooden Monopole) <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 10,000 <br /> NUMBER OF DEVICES(if low voltage): 2 <br /> FIRE ALARM? ❑YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 81706-003 <br /> DESCRIPTION OF WORK: The scope of work will include troubleshooting an existing alarm on the site, 1 <br /> and addressing a cabling issue on the tower. <br /> CONTACT INFORMATION <br /> OWNER NAME:Tacoma Place TIC TENANT NAME(If Commercial): T-Mobile <br /> OWNER MAILING ADDRESS: STREET PO BOX 5003 <br /> CITY Bellevue STATE WA ZIP 98009 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Steelhead Communications, Inc. <br /> CONTRACTOR ADDRESS: STREET 28120 State Route 410 E Suite A-3 <br /> co-v Buckley STATE WA ZIP 98321 <br /> CONTRACTOR PHONE: 360-829-1330 CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): STEELCI972BS jCITY OF EVERETT BUSINESS LIC.#(REQUIRED): 52133 <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR 0 OTHER(Please Specify) Consultant:MD7(Agent of T-Mobile) <br /> CONTACT NAME: CONTACT PHONE: 971-313-8915 <br /> Brent Sutter CONTACT EMAIL: bsutten@md7.com <br /> AGREEMENT:t hereby certify that I have read and examined this application and know the same to be true and correct AY provisions of laws and ordlnances governing this type <br /> of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That f am authorized by the owner of this properly to perform the work for which application is made and I <br /> comply with the State Contractors law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 3/-7l 14 E /5a?y"0 L D <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />