2605 15TH ST T MOBILE ANTENNA 2023-07-03

E B9LDING PERMIT APPLICATIN 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 2605 15th Street PARCEL#: 00386200600001 CITY Everett STATE WA ZIP 98201 SUITE/UNIT#: N/A FLOOR#: N/A ADDITIONAL LOCATION INFORMATION (if applicable): Rooftop TENANT/BUSINESS NAME(if non-residential):T-Mobile LEGAL DESCRIPTION for new construction: Short Plat/subdivision: N/A Lot No.: N/A (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Everett Housing Authority OWNER MAILING ADDRESS: STREET 3107 Colby Ave CITY Everett STATE WA ZIP 98201 OWNER PHONE:N/A OWNER EMAIL: N/A CONTRACTOR COMPANY NAME:True Compass LLC f WA STATE CONTRACTOR LICENSE#(REQUIRED):TRUECCL89ODG CITY OF EVERETT BUSINESS LICENSE#(REQUIR ): D ( CONTRACTOR ADDRESS: STREET 30810 152nd Ave SE CITY Kent • STATE WA ZIP 9 CONTRACTOR PHONE:253-833-9904 CONTRACTOR EMAIII:N/A i PRIMARY CONTACT: ❑OWNER Fl CONTRACTOR C✓J OTHER(Please Specify), CONTACT NAME: CONTACT PHONE:360-581-8189 Bryson Burg hardt CONTACT EMAIL:bryson.burghardt@smartlinkgroup.com BUILDING INFORMATION VALUATION OF WOR $45,000 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:V,l{reless Comm. Facility PROPOSED USE OF BUILDING:No Change HEAT SOURCE: ❑Gas ❑Electric ❑✓Other 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.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:Wireless Comm Facility DESCRIPTION OF WORK: Minor modification to existing rooftop wireless communication facility and equipment consisting of replacement of antennas and auxiliary equipment with new. Please see provided construction plans for more detailed information. 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. Digitally signed by Bryson Burgnamt City of Everett Official Use Only Bryson B u rg h a rdt DN: =net oa iry ou=sma Iinkllc na-users. PEpppp��IT# �r -Slteb ou=Klrklantl.WA,cn-Bryson Burghardt, ) ,V �� ema itbryson.bu rg hartlt@ sma nl Inkg roup.com Date:2021.06.1610:25:31-oroo' 6/16/2021 3 Owner/Authorized Agent Signature Date (Revised 2/8/2021) J/Z