319 76TH ST SW T MOBILE ANTENNA 2022-04-29

tLDING PERMIT APPLICAIAN 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 1(E)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 319 76th Street SW PARCEL#: 00392000006005 clry Everett STATE WA Zip 98203 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): Crown Castle on behalf of T-Mobile LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:City of Everett OWNER MAILING ADDRESS: STREET 319 76th Street SW CITY Everett STATE WA ZIP 98203 OWNER PHONE: OWNER EMAIL: J CONTRACTOR COMPANY NAME:TBD at Issuance Aitets k.c- N e, �k S D l I� -(—I CIVI S L L WA STATE CONTRACTOR LICENSE#(REQUIRED): M A-c-TEALri-b4iTY OF EVERETT BUSINESS LICENSE#(REQUIRED): "1-11113 CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR 0 OTHER(Please Specify) Crown Castle on behalf of T-Mobile CONTACT NAME: CONTACT PHONE:425-269-5561 Renata Fayten CONTACT EMAIL:renatasoffice@gmail.com BUILDING INFORMATION VALUATION OF WORK:$$25,000 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:U PROPOSED USE OF BUILDING:No Change HEAT SOURCE: ❑Gas ❑Electric ❑Other N/A BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ElCommercial ❑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) ZOther:Wireless equipment modification DESCRIPTION OF WORK: T-Mobile is proposing to modify its existing wireless facility by installing (3)AEHC Antennas and (1) HCS 2.0 Hybrid w/Pendant on an existing tower. As well as add equipment within the existing cabinet and install (1) HCS 2.0 J-Box within the existing leased ground space. ACKNOWLEDGEMENT'l 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.I 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. City of Everett Official Use Only PERMIT# g2M D ^00 S Renata Fayten Digitally by Renate Faylen Date.2021.09 821:06:3-0700' 09/28/21 Owner/Authorized Agent Signature Date (Revised 2/8/2021) /Z