9606 19TH AVE SE SBA COMMUNICATIONS 2024-11-07

ECE •LDING PERMIT APPLICATI•ONV CITY OF EVERETT PERMIT SERVICES ��i/ EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements an 1 n ber M�i'pi2 raqt2423or revi 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)PermitServices@everettwa.gov I(W)eJ rifty9a g i7pNERETT (Blue or Black Ink Only Please) PROJECT SITE INFORMATION Permit Services PROJECT SITE ADDRESS: sTREET' F 9610 19TH AVENUE SE PARCEL#: cln. EVERETT STATE WA ZIP 98208 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable):47.91032500;122.20s36111 TENANT/BUSINESS NAME(if non-residential):SBA Communications LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:SBA Communications OWNER MAILING ADDRESS: STREET 959 South Coast Drive Suite 200 CIT. Costa Mesa STATE CA ZIP 92626 OWNER PHONE:561-353-6541 pQ OWNER EMAIL: ruhl@sbasite.com CONTRACTOR COMPANY NAME:TBDD S P A W m VY1 tA11 i lift O r r WA STATE CONTRACTOR LICENSE#(REQUIRED):56 A N e 1J S TI1O H CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (9 6 0 6 4- CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:7203879088 Zoe Schneider CONTACT EMAIL:zschneider@ethossolutions.com BUILDING INFORMATION VALUATION OF WORK:$7700 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:TELECOMMUNICATIONS TOWER T-MOBILE/SPRINT PROPOSED USE OF BUILDING:REMOVE SPRINT EQUIPMENT HEAT SOURCE: ❑Gas ❑Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑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: removing a tenant-T- Mobile and Sprint . Cancel tenant power account and phone service. Leave the existing power meter for the future tenant. Remove the tenant's equipment on the ground and from the tower. The tower will remain with other tenants existing and will not change the tower structure 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 I 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 Zoe Schneider Dae:l2023.05.10123 36 06'00' 5/10/23 PERMIT# Owner/Authorized Agent Signature Date (Revised 4/21/2022)