1321 COLBY AVE BASE FILE 2025-04-16

• ID BUILDING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES MAY 0 4 2023 EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements an Or pf copies required for review, WASHINGTON then drop off completed application plus all required submittal documents to 3200 C rtSfre 1)2hd.Floorlr tr16-513p Box. CONTACT INFORMATION: (P)425-257-8810 I(E)PermitServices@everettwa.gov I( rettw ligteperciljtsec (Blue or Black Ink Only Please) i I PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 13 olby Ave PARCEL#: 00438524600000 CITY Everett STATE WA ZIP 98201 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential) LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Providence Health &Services of Washington OWNER MAILING ADDRESS: STREET 1801 Lind Avenue SW#9016 CITY Renton STATE WA ZIP 98057 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME:Mastec Network Solutions /7-- WA STATE CONTRACTOR LICENSE#(REQUIRED):MASTENS876KN CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 32359747001'00B3 CONTRACTOR ADDRESS: STREET22263 68TH aVE s CITY Kent STATE WA ZIP 98032 CONTRACTOR PHONE:866-545-1782 CONTRACTOR EMAIL:Fchang@rykaconsulting.com PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) Agent CONTACT NAME: CONTACT PHONE:206-372-5155 F u Chang CONTACT EMAIL:Fchang@rykaconsulting.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: PROPOSED USE OF BUILDING: HEAT SOURCE: ❑Gas ❑Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: 1 7Commercial ❑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:Replace 3 antennas on the rooftop DESCRIPTION OF WORK: AT&T proposes to modify and existing rooftop wireless communication facility consisting of 9 antennas by replacing 3 antennas with 3 new antennas. No changes in height proposed. No changes to the number of equipment cabinet proposed. Existing visual screening is proposed to be enlarged from 24" to 3'6" canisters 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 F u Chang DigDatle:12023.02.14 signed y Fu Chang 12:31 42 08'00' 5/1/23 PERMIT# I Owner/Authorized Agent Signature Date (Revised 4/21/2022)