1121 SE EVERETT MALL WAY EVERETT POLICE DEPT SOUTH PRECINCT 2023-02-06

El BBILDING PERMIT APPLICA1N CITY OF EVERETT PERMIT SERVICES EV E R E T T 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 1121 SE Everett Mall Way PARCEL#: 280518 004 023 00 cnv Everett STATE WA ZIP 98208-2832 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): 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 CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NA : BD P IA) I re,ks S S S Gam"'`S 7 WA STATE CONTRACTOR LICE (REQUIRED). QA3 W%S 9& id.CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5 I +f/ CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) Agent CONTACT NAME: CONTACT PHONE:206_523_3764 Michael Aippersbach CONTACT EMAIL:maipp@comcast.net lAll DING INFORMATION VALUATION OF WOIj 24-) v ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the p fair market val ,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING:91 1 Emergency Communication facility PROPOSED USE OF BUILDING:Same as existing HEAT SOURCE: ❑Gas ❑Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑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) ❑Other: DESCRIPTION OF WORK:Exchange (1) microwave antenna and add (2) microwave antennas on the existing 180 foot tower. Some radio equipment will be updated and additional equipment racks will be installed in the existing equipment shelter. 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 l�Cn PERMIT# Z I O 4^ O 4-J . ,,, �L,i � 4/12/2021 Owner/Authorized Agent Signature Date (Revised 2/8/2021) ! ,.._.