709 80TH ST SW T MOBILE ANTENNA 2023-08-08

E BADING PERMIT APPLICATI0 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 l(E)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 709 80TH ST SW EVERETT,WA 98203 PARCEL#: 00412300000700 cry EVERETT STATE WA ZIP 98203 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):American Tower LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:JEANNE WILL OWNER MAILING ADDRESS: STREET 9225 60TH AVE W CITY MUKILTEO STATE WA ZIP 98275 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME:TBD WA STATE CONTRACTOR LICENSE#(REQUIRED): ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ©OTHER(Please Specify) Applicant Agent CONTACT NAME: CONTACT PHONE:206.295.5926 Vinh Dinh for ATC & T-Mobile CONTACT EMAIL:vdinh@infinigy.com BUILDING INFORMATION VALUATION OF WORK:$20,000 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 Telecommunication Tower PROPOSED USE OF BUILDING:no change HEAT SOURCE: ❑Gas ❑Electric ©Other None BUILDING TYPE: DSFR ❑Townhouse ❑Duplex DADU DMulti-Family-#Units: ©Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ©Remodel ©Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable ORe-roof ®Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK:THE PROPOSED PROJECT INCLUDES MODIFYING GROUND BASED AND TOWER MOUNTED EQUIPMENT AS INDICATED PER BELOW: •REMOVE(6)SPRINT PANEL ANTENNAS,(1)SPRINT EQUIPMENT CABINET, (6)SPRINT RADIOS •INSTALL(3)AEHC(MIMO)PANEL ANTENNAS,(3)COMMSCOPE FFW-65C-R3-V1 PANEL ANTENNAS, (6)NOKIA AHFIG RADIOS •INSTALL(1)HPL3 600A DC POWER PLANT CABINET,(1)LB3 BATTERY CABINET •INSTALL(2)ASIK BASEBAND MODULE AT GROUND LEVEL,(2)ASIB BASEBAND MODULES AT GROUND LEVEL, (4)ABIL BASEBAND MODULES AT GROUND LEVEL •INSTALL(3)ABIC BASEBAND MODULES AT GROUND LEVEL, (1)FSMF BASEBAND MODULE AT GROUND LEVEL,(3)ABIA BASEBAND MODULES AT GROUND LEVEL •INSTALL(2)AMIA BASEBAND MODULES AT GROUND LEVEL, (1)VOLTAGE BOOSTER POWERPLUS, (2)RAYCAP AMPLIFIERS •INSTALL(1)IXRe V2 AT GROUND LEVEL,(1)H-FRAME AT GROUND LEVEL,(1)PPC CABINET AT GROUND LEVEL •INSTALL(1)TELCO CABINET AT GROUND LEVEL 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 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. City of Everett Official Use Only PERMIT# n b 7.20.201 Owner/Authorized Agent Signature Date (Revised 2/8/2021)