2715 EVERETT AVE VERIZON ANTENNA 2022-11-16

— • • BUILDING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETTSUBMITTAL 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 2715 Everett Ave PARCEL#: 29052000106900 CITY Everett STATE WA ZIP 98201 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):Tilson Technology on behalf of Verizon Wireless LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Sec 20 T29 R05 Lot No.: 6900 (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Bethany Christian Assembly(Paul Banas) OWNER MAILING ADDRESS: STREET 2715 Everett Ave CITY Everett STATE WA ZIP 98201 OWNER PHONE:425-339-3303 ext 109 OWNER EMAIL: CONTRACTOR COMPANY NAME:TBD pending bid award 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) Tilson Technology on behalf of Verizon(consultant) CONTACT NAME: CONTACT PHONE:503-888-9317 Alicia Vore/Tilson Technology on behalf of Verizon Wireless CONTACT EMAIL:avore@tilsontech.com BUILDING INFORMATION VALUATION OF WORK:$20,000 ASSOCIATED 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:Existing Wireless Tower on existing utility Pole PROPOSED USE OF BUILDING:modification to existing wireless tower on existing utility Pole HEAT SOURCE: ❑Gas ❑Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ECommercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ERemodel ❑Repair ❑T.l. ❑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: DESCRIPTION OF WORK: Propose to modify existing wireless facility on an existing utility pole in the ROW by removing (3) antennas, (3) diplexers and replacing with (6) new antennas, (12) diplexers, (2) Surge suppressors and associated cables. 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 ��AA nq PERMIT#O411,6A, /Authorized Agent Signature Date (Revised 2/8/2021) %Z