1802 75TH ST SW T MOBILE 2023-06-29

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 INFORA INFORMATION PROJECT SITE ADDRESS: STREET 1802 75th �r. j II) S IV PARCEL#: 00392200000300 ciTY Everett STATE WA ZIP 98203 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable):Tower TENANT/BUSINESS NAME(if non-residential):T-Mobile LEGAL DESCRIPTION for new construction: Short Plat/subdivision: See site plan for legal Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Public Utility Dist 1 SNO CO OWNER MAILING ADDRESS: STREET 2320 California St coy Everett STATE WA Zip 98206 OWNER PHONE:N/A OWNER EMAIL: N/A CONTRACTOR COMPANY NAME:True Compass LLC WA STATE CONTRACTOR LICENSE#(REQUIRED):TRUECCL890DG CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5 5r),L' CONTRACTOR ADDRESS: STREET 30810 152nd Ave SE CITY Kent STATE WA ZIP 98042 CONTRACTOR PHONE:253-833-9904 CONTRACTOR EMAIL:N/A PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR t OTHER(Please Specify) Agent for T-Mobile CONTACT NAME: CONTACT PHONE:360-581-8189 Bryson Burghardt CONTACT EMAIL:bryson.burghardt@smartlinkgroup.com BUILDING INFORMATION VALUATION OF WORK:$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:Wireless Comm. Facility PROPOSED USE OF BUILDING:No Change HEAT SOURCE: EGas ❑Electric ©Other N/A BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: l27Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction EAddition ❑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 wireless communication tower and and ground equipment consisting of replacement of antennas, auxiliary, and ground 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.lam the owner,or lam 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 Burghardt City of Everett Official Use Only DN:dmnet,dc=truaiity,ou=srnartiinklIc,ou=users, PERMIT# Bryson Burghardt`:.2,!eb ou=Kirkland,WA,cn=Bryson Burghardt, ^ b e �� -email=bryson.buryhaMt@smaNinkgroup.com / Date:2021.08.05 09:52:13-0T00' 8/5/2021 Owner/Authorized Agent Signature Date (Revised 2/8/021)