9610 19TH AVE SE DISH WIRELESS 2023-11-01

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 1 (E) PermitServices@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 zIP 98208 SulE/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 zIP 98033 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME: Zenisco Inc WA STATE CONTRACTOR LICENSE #(REQUIRED): ZENISI*848RB CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 60999 CONTRACTOR ADDRESS: STIEET4580 KLAHANIE DR SE, Num 281 CITY Issaquah STATE WA ZIP 98029 CONTRACTOR PHONE: 425-321-2300 CONTRACTOR EMAIL: Brandon. Brock@zenisco.com PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR 0 OTHER (Please Specify) CONTACT NAME: William Powell CONTACT PHONE: 253-225-5870 CONTACT EMAIL: wpowell@sbasite.com BUILDING INFORMATION VALUATION OF WORK: $ 33000.00 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: 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 Z]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,xT 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 1 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. .=e William W Powell .°°° es�°5°eCOm 03/24/2023 Owner/Authorized Agent Signature Date City of Everett Official Use Only PERMIT # B2203-074 (Revised 412112022)