9610 19TH AVE SE DISH WIRELESS 2026-01-06

B' 'LDING PERMIT APPLICA" :)N 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 1(E)everetteps@everettwa.gov I (W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 9610 19th Ave SE PARCEL#: 28051800406500 CITY Everett STATE WA Zlp 9$20$ SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): Cell Tower TENANT/BUSINESS NAME(if non-residential):Dish Wireless LLC LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Premier Storage Everett LLC OWNER MAILING ADDRESS: STREET 5729 Lakeview Dr NE, Suite 200 CITY Kirkland STATE WA Zlp 98033 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME:TBD jO-W-w Llbtl WA STATE CONTRACTOR LICENSE#(REQUIRED): -fQ L g��4 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZfP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR 0 OTHER(Please Specify) Development Consultant CONTACT NAME: CONTACT PHONE:253-225-5870 William Powell CONTACT EMAIL:wpowell@sbasite.com BUILDING INFORMATION VALUATION OF WORK:$33000.00 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: ❑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: DESCRIPTION OF WORK: Dish Wireless to install 3 new antennas along with associated radios and cabling to the existing tower. The ground equipment is to be installed on an a new 5'x7' concrete pad within the existing fenced compound. 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/comply with the State Contractojrs Law 18.27 RCW and 296.200A WAC. // ^�J/Z3 ZZ PERMIT# City of Everett Official Use Only /�j g ZZ o 3 0 7�- Owner/Authorized Agent Signature Date (Revised 21812021) r