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• <br /> Imo <br /> BUILDING PERMIT APPLICATION ECEOVIE <br /> CiTY OF EVERETT PERMIT SERVICES ((l�C�(('+ <br /> EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements lilt umbMbtbojie&re�nn <br /> jU for re <br /> WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop x. <br /> CONTACT INFORMATION:(P)425-257-8810 I(E)PermitSeivices@everettwa.gov I(Vetr [ttOPc FTT <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION Permit Services <br /> PROJECT SITE ADDRESS: STREET 2517 Howard Ave PARCEL#: 5447 014 025 00 02 <br /> ary Everett STATE WA zip 98203 <br /> SUITEJUNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential):SP " a -� TIC 4/ 7�0i¢r,_S <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Magestic Views <br /> OWNER MAILING ADDRESS: STREET PO BOX 6368 <br /> Ct7Y Lynnwood STATE WA ZIP 98036 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME MasTec Network Solutions `:%(€ °, <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):MASTENS876KN CITY OF EVERETT BUSINESS LICENSE#(REQUIRED <br /> CONTRACTOR ADDRESS: STREET 3443 Airport Road <br /> ciTy Sacramento STATE CA ZIP 95834 <br /> CONTRACTOR PHONE:224-325-8043 CONTRACTOR EMAIL:Alana.Neal@mastec.com <br /> PRIMARY CONTACT: 0 OWNER ©CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:224-325-8043 <br /> Alana Neal CONTACT EMAIL:Alana.Neal@mastec.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$20000 ASSOCIATED LAND USE PROJECT#(if applicable): <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:Unmanned Wireless Telecommunications Facility <br /> PROPOSED USE OF BUILDING:No Change <br /> HEAT SOURCE: OGas OElectric ❑Other <br /> BUILDING TYPE: OSFR DTownhouse ❑Duplex DADU DMulti-Family-#Units: i2iCommercial DAccessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction DAddition ORemodel ORepair OT.I. DChange of Use <br /> DModular DPortable ORe-roof ❑ExteriorAlteration OTank(above ground) OAccessory Structure <br /> OFence over 7ft high ❑RackStorage OPool/Hot Tub DTank(above ground) Other:Removal of Sprint/T-Mobile Equipment <br /> DESCRIPTION OF WORK: <br /> Sprint/T-Mobile Decommission and Removal <br /> Removing the following, but not limited to: <br /> (3) Panel Antennas, Mounts, and hybriflex lines,(3) RRUs, (2) Cabinets <br /> (1) Junction Box <br /> Remove PPC, Telco Box, Sector Frames, Chain Link Fence, Concrete Slab, remove <br /> debris and clear 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.I am the owner,or I am authorized by the owner of this properly 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 /> Alan a Neal Digitally eigned by Alma Neal <br /> n 023.11.29 16:07:32-05'00' 11/29/23 PERMIT It163(d• 05 <br /> Owner/Authorized Agent Signature Date (Revised 4/2112022) `� <br />