2420 39TH ST DISH WIRELESS 2025-04-22

BUILDING PERMIT APPLICATION 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 1 (E)PermitServices@everettwa.gov i(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREE,IIIIIIIIIIIIIIIIIIIIIIII� 2420 39th Street PARCEL#: 00576003200011 CITY EVERETT STATE WA z,P 98201 Sul E/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):Crown Castle for Dish Wireless LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Jack Sheeler OWNER MAILING ADDRESS: STREET 8919 Eastview Ave CITY Everett STATE WA ZIP 98208 OWNER PHONE:509-714-7494 OWNER EMAIL: vpeterson@lynxconsulting.org CONTRACTOR COMPANY NAME:= Pacific Northwest Towers PACIFNT834PU Applied 11/10/2022 WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET 4710 176th Avenue E CITY Lake Tapps STATE WA ZIP 98391 CONTRACTOR PHONE: 509-304-4933 CONTRACTOR EMAIL: nsobania@pnwtowers.com PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) Valerie Peterson,Lynx Consulting CONTACT NAME: CONTACT PHONE:509-714-7494 Valerie Peterson, Lynx Consulting CONTACT EMAIL:vpeterson@lynxconsulting.org BUILDING INFORMATION VALUATION OF WORK: $40,000.00 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:Wireless Communication Facility PROPOSED USE OF BUILDING:Wireless Communication Facility HEAT SOURCE: [-]Gas ❑Electric ❑Other n/a BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: FICommercial ❑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) Z10ther:Eligible Facilities Request modifications to WCF DESCRIPTION OF WORK: Install antenna platform, (3) panel antennas, jumpers, (6) RRUs, (1) OVP and (1) hybrid cable at tower. At ground, install concrete pad, ice bridge, (2) cabinets, power and telco conduit, utility box, (1) GPS unit and (1) meter socket on proposed H frame 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 1 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 4/26/2022 PERMIT# Owner/Authorized Agent Signature Date (Revised 412112022)