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V zNA/ d► ,7.-4G - -- <br /> mil • PPL izi BUILDING PERMIT A ICATtN <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT <br /> SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, <br /> WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> CONTACT INFORMATION:(P)425.257.8810 I(E)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 1602 Hewitt Ave PARCEL#: 00644968300300 <br /> CITY Everett STATE WA ZIP 98201 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): (Existing WCF) <br /> TENANT/BUSINESS NAME(if non-residential):Verizon Wireless (project: Deadwater Slouth, MW add) <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> _OWNER NAME:1602 Hewitt LLC <br /> OWNER MAILING ADDRESS: STREET PO Box 5267 <br /> CITY Everett STATE WA zip 98206 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME:TKO P -_+AL(.e, L-o M-M(,Ceti t tprItzo Ai S qiv - <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):PIS 6$C T-lkh3��I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0 3r7,r�g <br /> CONTRACTOR ADDRESS: STREET 1 5 u ( l�/i'l SF. N c,,) (A✓V' / (Ig,��/ <br /> CITY STATE k14 ZIP f�QQD` <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: Nl,c.P I`e,SG p ,Q din 44� -rc- <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ✓❑OTHER(Please Specify) Agent-Lynx Consulting for Verizon Wireless <br /> CONTACT NAME: CONTACT PHONE:206 972 1368 <br /> Aileen Zava I es CONTACT EMAIL:Azavales@lynxconsulting.org <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$5,000. ASSOCIATED LAND USE PROJECT#(if applicable):N/A existing rooftop WCF) <br /> (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING:Mixed Use/Urban <br /> PROPOSED USE OF BUILDING:No ch ange <br /> HEAT SOURCE: ❑Gas ❑Electric ❑Other NA <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: OCommercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑✓Other:WCF-microwave antenna addition at existing facility <br /> DESCRIPTION OF WORK: <br /> Verizon Wireless proposes to modify an existing facility: <br /> Add one 3" pipe mount; Add one 2'-2" Microwave Antenna; <br /> Add 2 CAT5e cables; <br /> Add 2 ODUs per plan <br /> 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 <br /> 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 <br /> Building Off ial 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, <br /> and I comq with the State o actors Law 18.27 RCW and 296.200A WAC. <br /> 1 l City of Everett Official Use Only <br /> V \ <br /> PERMIT ....192. [ I <br /> Own /Authorized Agent Si ature Date (Revised 2/8/2021) Vz_ <br />