1871 ROSS AVE VERIZON ANTENNA 2024-02-12

EMI LDING PERMIT APPLICAN 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 I(E)everetteps©everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 1871 Ross Ave PARCEL#: 29050900300100 CITY Everett STATE WA zip 98205 SUITE/UNIT#: N/A FLOOR#: N/A ADDITIONAL LOCATION INFORMATION(if applicable):Cell Tower(stealth flagpole) TENANT/BUSINESS NAME(if non-residential):Verizon (Wireless Communication Facility) LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Dagmars Manna LLC(Verizon owns the cell tower) OWNER MAILING ADDRESS: STREET 1871 Ross Ave cry Everett STATE WA zip 98201 OWNER PHONE:425-259-6124 OWNER EMAIL: dagmarsmanna@integra.net CONTRACTOR COMPANY BD 5'reg.L I Af 6- CQ/V( (,(P1/1 61'I1-0_nls ve CLPFSV/ WA STATE CONTRACTOR LICE SE EQUIRED): L,"i'CQ �I(tiq CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):99 416� CONTRACTOR ADDRESS: STREET e 0? 1 j 1 ✓ r'3 Tf ,S- cJ WA.' S)� f`O i CITY 1r'e r STATE (/l/ .'ar'f' .j�j % ZIP g Q lf S-kclir(/1 f-c- CONTRACTOR PHONE: � -� 5 76 'CONTRACTOR EMAIL: 9 ao A's Q ceo,\.) PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR m OTHER(Please Specify) Verizon Authorized Representative CONTACT NAME: CONTACT PHONE:253-278-2902 John Eder, J4 Site Solutions Inc. CONTACT EMAIL:john@j4sitesolutions.com BUILDING INFORMATION VALUATION OF WORK:$25,000 (ASSOCIATED LAND USE PROJECT#(if applicable):N/A-Eligible Facilities Request (Valuation shall include the prevaifng fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: Wireless Communication Facility PROPOSED USE OF BUILDING:No Change HEAT SOURCE: ❑Gas ❑Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: 21Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ONew Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable ORe-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub OTank(above ground) ©Other:Modify an existing wireless communication facility DESCRIPTION OF WORK: Eligible Facilities Request per the submitted letter. On the existing 150'flagpole tower, remove the existing 18'tall and 26"diameter solid canister stack and replace it with a 22'tall and 39"diameter vented canister stack, re-install the existing American flag and lighylnside the stealth canister stack, replace(6)antennas, remove(12)diplexer units, add (6)tr' lexer units, remove(3)of the existing(6) BIAS-T units, and install (3)OVP units. Inside the tower, add (3)new cables. Inside the equipment shelter, remove(12)quadplexers units, and relocate(9)remote radio units from the shelter to a new H-frame outside the shelter. 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 pertbnn 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 UseOnly n Eder �" � K� ��^ 08/27/2021 sr 0 - (X Owner/Authorized Agent Signature Date (Revised 2/8/2021) 4 z