3200 20TH ST T MOBILE ANTENNA 2023-10-26

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 3200 20th St PARCEL M 00563241100100 clrY Everett STATE WA z,P 98201 SUITE/UNIT M FLOOR M ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):T-Mobile LEGAL DESCRIPTION for new construction: Short Plat/subdivision: ST NICHOLAS ADD BLK 411 D-00 Lot No.: 1 TO 16 INC (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:State of Washington Department of Transportation OWNER MAILING ADDRESS: STREET 310 Maple Park Avenue SE P.O. Box 47300 CITY Olympia STATE WA Zip 98504 OWNER PHONE:360-705-7000 OWNER EMAIL: N/A CONTRACTOR COMPANY NAME:Wren Construction WA STATE CONTRACTOR LICENSE#(REQUIRED):CC WRENCI*013B6 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 38867 CONTRACTOR ADDRESS: STREET 16778 146th St Se Ste 134 CITY Monroe STATE WA ZIP 98272 CONTRACTOR PHONE:425-754-6186 CONTRACTOR EMAIL:Dan Hagy <danh@wrenconstruction.com> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-754-6186 Dan Hagy CONTACT EMAIL:Dan Hagy<danh@wrenconstruction.com> BUILDING INFORMATION VALUATION OF WORK: $45000 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: [-]Gas ❑Electric DOther N/A BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: FICommercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition [-]Remodel [-]Repair ❑T.I. ❑Change of Use ❑Modular [-]Portable ❑Re-roof DExterior Alteration [-]Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub [-]Tank(above ground) Z10ther: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.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. City of Everett Official Use Only Digitally signed by Bryson PERMIT# Bryson Burghardt Burghardt 8/21/2023 Date:2023.08.21 14:24:57-07'00' Owner/Authorized Agent Signature Date (Revised 4/21/2022)