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41 <br /> BUILDING PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, <br /> WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> CONTACT INFORMATION:(P)425.257.8810 I(E)everetteps@everettwa.gov l(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please)' PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 1602 Hewitt Avenue PARCEL#: 00644968300300 <br /> . <br /> crry Everett STATE WA ZIP 98201 <br /> SUITE/UNIT#: N/A FLOOR#: N/A ADDITIONAL LOCATION INFORMATION(if applicable):Rooftop <br /> TENANT/BUSINESS NAME(if non-residential):VeriZon Wireless <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION, <br /> OWNER NAME: 1602 Hewitt LLC,Attn Andrew Skotdal <br /> OWNER MAILING ADDRESS: STREET 2707 Colby Avenue, Suite 1200 <br /> C,N Everett STATE WA ZIP 98201 <br /> OWNER PHONE:(425)252-5400 ext 141 OWNER EMAIL: o <br /> CONTRACTOR COMPANY NAME: TBD S f\�y\pt ¶-ekt .O- i ry t L' I ors L co m S 1t(/tth al-_ <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): S 1 E I.`(')C O p g4ITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5 0 1'6.9 <br /> CONTRACTOR ADDRESS: STREET TBD <br /> CITY TBD STATE TBD ZIP TBD <br /> CONTRACTOR PHONE: TBD CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) As Agent for Verizon Wireless <br /> CONTACT NAME: CONTACT PHONE:206-992-1684 <br /> • Leslie Bradley/Morrison Hershfield CONTACT EMAIL:lbradley@morrisonhershfield.corn <br /> BUILDING INFORMATION• <br /> VALUATION OF WORK:$10,000 ASSOCIATED LAND USE PROJECT#(if applicable): N/A <br /> (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING: Existing Commercial Building <br /> PROPOSED USE OF BUILDING:No change to the existing use of the building. <br /> HEAT SOURCE: OGas ❑Electric ❑✓Other N/A <br /> BUILDING TYPE: ❑SFR ❑Townhouse ElDuplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ElExterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑✓Other:Modify existing telecommunications egiuipment on rooftop <br /> DESCRIPTION OF WORK:Verizon Wireless is proposing modifications to the existing WCF located on the rooftop <br /> of the existing building. More specifically, to remove four(4) existing antennas and <br /> replace with four(4) new make/model antennas and supporting RRU's (one per <br /> sector). Additionally, to add eight(8) new combo antennas/internal RRU's within the <br /> individual antenna housing structure. Lastly add two (2) -8' long horizontal pipes to <br /> accomodate mounting of the new antenna/RRU units on the Delta sector. No other <br /> work is proposed at this site. <br /> 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 <br /> 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 <br /> 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, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only '— <br /> Leslie Bradley/Morrison Hershfield PERMIT# R^ I tQ— A 3; <br /> as Agent for Verizon Wireless jar 9/3/2021 L l <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) • <br />