4634 ALGER AVE VERIZON WIRELESS ANTENNA 2023-12-06

BALDING PERMIT APPLICAT 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)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) - PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 4634 Alger Ave PARCEL#: 00412000101300 CITY Everett STATE WA zip 98203 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):Tilson Technology on behalf of Verizon Wireless LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Sec 31 T29 R05 Lot No.: 1300 (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Zion Lutheran Church-Everett OWNER MAILING ADDRESS: STREET P.O. Box 2116 CITY Everett STATE WA zip 98213 OWNER PHONE:425252-1429 OWNER EMAIL: infozionlutheraneverett@gmail.com CONTRACTOR COMPANY NAME:TBD WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR Z OTHER(Please Specify) Applicant CONTACT NAME: CONTACT PHONE:503-888-9317 Alicia Vorefrilson Technology on behalf of Verizon Wireless CONTACT EMAIL:avore@tilsontech.com BUILDING INFORMATION VALUATION OF WORK:$20,000 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:Existing Wireless Tower on existing utility Pole PROPOSED USE OF BUILDING:modification to existing wireless tower on existing utility Pole HEAT SOURCE: ❑Gas ❑Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse EDuplex ❑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: Propose to modify existing wireless facility on an existing utility pole in the ROW by removing (6) antennas and replacing with (6) new antennas. 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. City of Everett Official Use Only PERMIT# �� f i4� U /D.off j/c&i c 'ner/Authorized Agent Signature Date (Revised 2/8/2021)