906 SE EVERETT MALL WAY A T AND T MOBILITY ANTENNAS 2025-01-14

BOLDING PERMIT APPLICAiN 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 906 SE EVERETT MALL WAY PARCEL#: 28051800308500 CITY Everett STATE WA zip 98208 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):AT&T Mobility LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:PFLUEGER-EVERETT HOLDINGS LLC OWNER MAILING ADDRESS: STREET 601 UNION ST#5300 clry SEATTLE STATE WA zip 98101 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME:Mastec Network Solutions, LLC WA STATE CONTRACTOR LICENSE#(REQUIRED):MASTENS876KN CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET 22263 68th Ave S cln. Kent STATE WA ZIP 98032 CONTRACTOR PHONE:231-527-5269 CONTRACTOR EMAIL:Michael.Sutherby@mastec.com PRIMARY CONTACT: ❑OWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:815-252-1667 Bernard Dumyahn,Mastec Network Solutions,LLC CONTACT EMAIL:Bernard.Dumyahn@mastec.com BUILDING INFORMATION VALUATION OF WORK:$25,000.00 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:Existing -Cellular Communications Facility PROPOSED USE OF BUILDING:Existing - Cellular Communications Facility 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.l. 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: AT&T-SN86 Antenna Mod; Removing (9) antennas, removing (6) Diplexers, removing (5) TMA's, removing (3) RRH's, adding (6) antennas, replacing (3) RRH's, and ancillary equipment to existing facility. ACKNOWLEDGEMENT:1 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/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 PERMIT# F� ^ Bernard Dumyahn Bernard Dumyahn 1:),e 2o22o 18 13 3855-05.00. 07/18//2022 O`)� Owner/Authorized Agent Signature Date (Revised 2/8/2021) ll