2520 MADISON ST T MOBILE ANTENNA 2022-05-27

• • am in 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 0t lyPlease); ��PROJECT SITE INFORMATION OMNI PROJECT SITE ADDF( S Madison ST PARCEL S: STREET 2520 Mo �� ~ #: 28050800200100 cry Everett ' ry STATE WA Zip 98203 SUITE/UNIT#: FLOOR#:��r ADDITIONAL LOCATION INFORMATION(if applicable): TENANT/BUSINESS L ME(if non-residential):American Tower Company' � fI LEGAL DESCRIPTIOteJ fbr new construction: Short Platlsubdivision: Lot No.: ad (attach copy of long egal description) 11111. �.„. NW niqup CONTACT INFORMATION Aa :.." ?moo m411. ..9. RHgtl OWNER NAME:Sunrise View Retire Villa INC "M OWNER MAILING ADDRESS: STREET 2630 Madison ST ro.. CITY Everett YT STATE WA ZIP 98203 OWNER PHONE: 'OWNER EMAIL: 4Y CONTRACTOR COMPANY NAME:• &— /VtCj1-e-C_ m ., WA STATE CONTRAQT'OR LICENSE#(REQUIRED): ASTEJ),vnK CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 7 L/NT 3 CONTRACTOR ADDRESS: STREET �„.. CITY _ STATE ZIP CONTRACTOR PHONE _ 'CONTRACTOR EMAIL:• PRIMARY CONTACT: .0 OWNER ❑CONTRACTOR Z OTHER(Please Specify) Applicant Agent CONTACT NAME: CONTACT PHONE:206.295.5926 MY _. Vinh Dinh for ATC & wl.-Mobile • • CONTACT EMAIL:vdinh.ctr@infinigy,com .. rymm.;.. Wn. BUILDING INFORMATION �`� VALUATION OF WORKS$20,000 ASSOCIATED LAND USE PROJECT#lit applicable): (Valuation shall include the prj.=.0 ii ng fair market value of all labor;materials,and equipment needed to omplete the work,whether actua lypaid or not) EXISTING USE OF Bt#ILDING:Wireless Telecommunication Tower y.�,. rw,.r w. PROPOSED USE OF BUILDING:No change HEAT SOURCE: ❑ qs DElectric ZOthernone "�" BUILDING TYPE: ❑$FR ❑Townhouse ❑DUptex ❑ADU ❑Multi-Fatrirdly-#Units: k 1C:ommercial ❑Accessofy Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑✓Remodel DRepair ❑T.I. ❑Change of Use ❑Modular ❑Portably ❑Re-roof I.>/7Exterior Alteration ❑Tank(above Aground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hct Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WO AK:THE PROPOSED PROJECT'NZ DES MODIFYING GROUND BASED—AND TOWER MOUNTED EQUIPMENT AS INDICATED PER BELOW: M TOWER WORK: REMOVE T-ARM INSTALL(I)LOW PROFILE PLATFORM MOUNT(S),(1))DUAL COLLARK/Os),UNT(S),,TMA(9)ANTENNA(S),(6)RRH(s),(3)TMA(s),(6)D PLEXER(S)(2)AND(1)NSN LOWCAP HCS PENDANT(S),(3) FPKA BRACKET(S),AND(2)HCS 2.0 TRUNK(S). EXISTING(1)RRH(s)AND(6)713"COAX CABLE(S)TO REMAIN. GROUND WORK: REMOVE(2)ULTRASITE OUTDOOR CABINET(S),(1)2G PURCELLCA3INET(S),(1)LARGE COVP(s),(1)IVCAP(s),(1)FSMF(s),(1)FSME(s),(1)FBE.A(s),(3)FRIA(s), (3)FRIG(s),(2)FXFB(s),AND(1)43SR 7210 SAS-MXP(S). INSTALL(1)PURCELL HPL3 600A DC PLANT(S),(1)PURCELL LB3 BATTERY CABINET(S),(2)HCS 2.0 TC WEER JUNCTION BOX(ES),(2)ASIK(s),('2)ASIB(s),(6)ABIL (s),(3)ABIC(s),(3)ABIA(s),(2)Af 6A(s),(4)AMPLIFIER(S),(1)VOLTAGE BOOSTER(S),(1)FRIE(s),AND(1)CSRIXRE V2(s). EXISTING(1)ESMB(s)TO REMAIN. 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 a wd no deviations therefrom.Devl'ret±arms must first be authorized in writing from the Building Official before being authorized under any circumstan e,I am the owner,or I am authorized by the owner of this properly to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and-296.200A WAC. UM.City of Everett Official Use Only / PERMIT# �/ 10.5.2021 '1 \ (; ` W Owner/Authorized Agent) ognature Date .,. '2( Z