2215 MERRILL CREEK PKY A T AND T WIRELESS ANTENNA 2023-02-06

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 2215 Merrill Creek Pkwy PARCEL#: 28040200300300 CRY Everett STATE WA ZIP 98203 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): Crown Castle on behalf of AT&T LEGAL DESCRIPTION for new construction: Short Plat/subdivision: SEC 02 TWP 28 RGE 04 Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Polo Properties LLC OWNER MAILING ADDRESS: STREET 3248 Hunts Point Rd CITY Bellevue STATE WA ZIP 98004-1126 OWNER PHONE: p OWNER EMAIL: ",c CONTRACTOR COMPANY NAME: . D 6t t _ MWiti 4 Q G k1lON� :,J C- WA STATE CONTRACTOR LICENSE#(REQUIRED):DRC O/ut I B33RR CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET g©i Q IS(� C{ I L ZS �V� `✓ CITY C 1.1V k L S STATE L)Pr- ZIP ce✓�� CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ©OTHER(Please Specify) Crown Castle on behalf of AT&T 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: OGas ElElectric ['Other N/A BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ✓❑Commercial DAccessory 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) ElAccessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ©Other:Wireless equipment modification DESCRIPTION OF WORK: AT&T is proposing to modify their existing wireless facility by replacing (6)Antennas with (6) new Antennas, removing (6) TMAs, modifying the mount, and installing (3) RRHs, (1) Raycap Squid and (1) DC Hybrid Trunk on an existing tower. As well as replacing (3) cabinets with (3) new cabinets. 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# 1�f1-� �t f1 Renata Fayten ; tl,2 -07W 09/16/21 l/ E I O 1 '. v (0 1 Owner/Authorized Agent Signature Date (Revised 2/8/2021)