220 OLYMPIC BLVD T MOBILE ANTENNA 2023-06-30

BUILDING • PERMIT APPLICATI Oism 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 1(E)PemnitServices@everettwa.gov I(VV)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 220 Olympic Blvd PARCEL#: 006062-000-041-02 ciry Kirkland STATE WA zip 98034 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):T-Mobile West LLC LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Global Signal Acquisitions IV LLC OWNER MAILING ADDRESS: STREET P.O. Box 277455 CITY Atlanta STATE GA Zip 30384 OWNER PHONE:(724)416-2000 OWNER EMAIL: seattle@crowncastle.com CONTRACTOR COMPANY NAME ) A-CO AA- e."1-J 1 'n WA STATE CONTRACTOR LICENSE#(REQUIRED):�'�tE I� h CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):' 6 4' ' CONTRACTOR ADDRESS: STREET TBD CITY TBD STATE TBD ZIP TBD CONTRACTOR PHONE:TBD CONTRACTOR EMAIL:TBD PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ID OTHER(Please Specify) Advantage Engineers,applying on behalf of T-Mobile CONTACT NAME: CONTACT PHONE:818-257-9331 Andrew Lawson CONTACT EMAIL:alawson@synergy.cc BUILDING INFORMATION VALUATION OF WORK:$130,000 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:Telecommunications tower PROPOSED USE OF BUILDING:Modification of telecommunications tower 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:Modification of cellular equipment DESCRIPTION OF WORK: SE01685B_Anchor: REMOVE (3) RRU AND (1) COVP, (1) HYBRID CABLE FINAL- (6) ANTENNA, (2) HCS 2.0, (6) RRU ADD (3) ANTENNA, (2) HCS 2.0, (3) RRU Extending tower 5' to accommodate new platform mount 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 Andrew Lawson Digitally signed by Andrew Lawson PERTM L^ 01 Date:2022.04.21 141159-07'00' di Owner/Authorized Agent Signature Date (Revised 4/21/2022) /2.