309 E CASINO RD VERIZON WIRELESS 2023-08-08

sl• EVERETT WASHINGTON EALDING PERMIT APPLICAAN CITY OF EVERETT PERMIT SERVICES SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review, then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION: (P) 425.257.88101(E) everetteps@everettwa.gov I (W) everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 309 E Casino Road PARCEL M 00598700000101 CITv Everett STATE WA zjp 98208 SUITE/UNIT #: N/A FLOOR #: N/A ADDITIONAL LOCATION INFORMATION (if applicable): Romp, and behind budding TENANT/BUSINESS NAME (if non-residential): Vedzon LEGAL DESCRIPTION for new construction: Short Plat/subdivision: N/A Lot No.: N/A (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: BJJ Investments LLC OWNER MAILING ADDRESS: STREET 8380 SE 43rd St cITY Mercer Island STATE WA ap 98040 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME: TBD AC-" A \ WA STATE CONTRACTOR LICENSE #(REQUIRED): -I 0 $S� CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): % 3 $ 3 CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR Z OTHER (Please Specify) Authorized Rep for Verizon (Applicant) CONTACT NAME: John Eder, J4 Site Solutions, Inc. CONTACT PHONE: 253-278-2902 CONTACT EMAIL: john@j4sitesolutions.com BUILDING INFORMATION VALUATION OF WORK: $10,000 1ASSOCIATED LAND USE PROJECT # (if applicable): N/A (Valuation shall include the prevailing fair market value of all labor, materials, and equipment needed to complete the work, whether actually paid or not.) EXISTING USE OF BUILDING: Commercial/Retail (wireless communication facility as a secondary use) PROPOSED USE OF BUILDING: No change HEAT SOURCE: []Gas ❑Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT (check all that apply) : ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use []Modular ❑Portable ❑Re -roof ❑Exterior Alteration []Tank (above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank (above ground) ©Other: Modification to a Wireless Communication Facility DESCRIPTION OF WORK: Add (3) panel antennas on existing (empty) pipe mounts on the rooftop of the existing building. No other proposed changes. 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 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 Building Official before being authorized under any circumstance. l am the owner, or I am authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. PERMIT # City of Everett Official Use Only -t^ John Eder 3/1/2021 Owner/Authorized Agent Signature Date (Revised ZS 2021) /Z