1802 75TH ST SW VERIZON ANTENNA 2022-04-29

• BUILDING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION:(P)425.257.8810 (E)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 1802 75th Street SW PARCEL#: 00392200000300 cm,Everett STATE WA ZIP 98203 SUITE/UNIT#: - FLOOR#: - ADDITIONAL LOCATION INFORMATION(if applicable): TENANT/BUSINESS NAME(if non-residential): Verizon Wireless LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Public Utility District 1 Snohomish County OWNER MAILING ADDRESS: STREET 1802 75th Street SW cm, Everett STATE WA ZIP 98203 OWNER PHONE:(425)783-1000 OWNER EMAIL: CONTRACTOR COMPANY NAME: TBD J 0 I/ l A WA STATE CONTRACTOR LICENSE#(REQUIRED): TBD Jo, t I k%3I. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): TBD 4 1 3g-5 CONTRACTOR ADDRESS: STREET TBD cnv TBD STATE TBD Zip TBD CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR lI OTHER(Please Specify)As Agent for Verizon Wireless CONTACT NAME: CONTACT PHONE: 206-992-1684 Leslie Bradley/Morrison Hershfield CONTACT EMAIL:Ibradley@morrisonhershfield.com BUILDING INFORMATION VALUATION OF WORK:$ 10,000 ASSOCIATED LAND USE PROJECT#(if applicable): (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: Existing wireless telecommunications monopole. PROPOSED USE OF BUILDING: No change to the existing use. HEAT SOURCE: ❑Gas DElectric ❑✓Other N/A BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction DAddition ❑Remodel ❑Repair DT.I. ❑Change of Use ❑Modular ❑Portable ❑Re-roof DExterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑✓Other: DESCRIPTION OF WORK:Verizon Wireless is proposing to modify their existing WCF located on the existing monopole owned by SnoPUD. More specifically,to install three (3) new antennas, one (1) per sector to support the new 5G technology. No other modifications are proposed for this site for the purposes of this application. 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/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. City of Everett Official Use Only Leslie Bradley/Morrison Hershfield p // PERMIT 1 ^/.' as Agent for Verizon Wireless ` he.1-.J/ ,,, O"`j 11/2/2021 1 ' l— ©`'' Owner/Authorized Agent Signature ��UUII g+ritr LX Date (Revised 2/8/2021) f