9606 19TH AVE SE VERIZON ANTENNA 2023-06-23

BUILDING PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 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) Al,n( PROJECT SITE INFORMATION PROJECT SITE ADDRESS: sTREET,9611519th Ave SE PARCEL#: 28051800406500 crry Everett STATE WA Zip 98208 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): Cell tower TENANT/BUSINESS NAME(if non-residential):Verizon LEGAL DESCRIPTION for new construction: Short Plat/subdivision: see attached Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Les Cooley-for Verizon OWNER MAILING ADDRESS: STREET 13630 SR 9 SE CITY Snohomish STATE WA ZIP 98296 OWNER PHONE:425-530-2945 OWNER EMAIL: les@sage-hill.com CONTRACTOR COMPANY NAME:TBD-Verizon Contractor will be assigned later to provide license info&City Bus Lic. WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-530-2945 Les Cooley CONTACT EMAIL: les@sage-hill.com BUILDING INFORMATION VALUATION OF WORK:$16,800.00 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:Cell Tower PROPOSED USE OF BUILDING:Cell Tower HEAT SOURCE: EGas ❑Electric I lOther N/A 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.1. ❑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:Cell Tower-see plans DESCRIPTION OF WORK: Remove 9 exisiting antennas and replace with 12 new antennas , Remove 3 RRU's & replace with 3 new RRU's, add 1 OVP (surge protector) and 1 new hybrid cable per plans. 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!am authorized by the owner of this property to perform the work for which application is made, and I comply with the Sta ontractors Law 18.27 RCW and 296.200A WAC. 4 City of Everett Official Use Only 8/11/21 l Owner/Authorized Agent slfi ure Date (Revised 2/8/2021)