129 112TH ST SE 2022-05-02 - Laserfiche WebLink

— • • 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 I(E)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 129 112th St SE PARCEL#: 28042400408700 c,TY Everett STATE WA ZIP 98208 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):Sprint Wireless LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Pole: Snohomish County PUD. Ground:Adams Georgelee OWNER MAILING ADDRESS: STREET 129 112th St. SE CITY Everett STATE WA ZIP 98208 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME:TBD WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ©OTHER(Please Specify) Applicant CONTACT NAME: CONTACT PHONE:206-818-9995 Catherine Funtanilla CONTACT EMAIL:cfuntanilla@qualtekwireless.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:N/A PROPOSED USE OF BUILDING:N/A HEAT SOURCE: ❑Gas ❑Electric ❑OtherN/A BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ECommercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ENew Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ETank(above ground) ❑Accessory Structure EFence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK:Removal of Sprint Wireless antennas, antenna mounts, RRUs and coax lines from existing utility pole. Utility pole to remain. Equipment cabinet, fencing around equipment, concrete pad, meter and any underground lines to be removed. 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.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# 2 ut2 Puott¢nue&2 04/26/2021 \3 2 I 0 Owner/Authorized Agent Signature Date (Revised 2/8/2021) 12_