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BUILDING PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT <br /> SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review, <br /> WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> CONTACT INFORMATION: (P)425-257-8810 1 (E)PermitServices@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 2605 15th St. PARCEL#: 003862006000001 <br /> CITY Everett STATE WA z,P 98201 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable):Roof <br /> TENANT/BUSINESS NAME(if non-residential):Bakervlew Apartments <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Housing Authority of Everett <br /> OWNER MAILING ADDRESS: STREET 3107 Colby Ave. <br /> CITY Everett STATE WA ZIP 98206 <br /> OWNER PHONEA25-303-1 128 1OWNER EMAIL: info@evha.org <br /> CONTRACTOR COMPANY NAME:Legacy Telecommunications <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):LEGACTL821 LL I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 42661 <br /> CONTRACTOR ADDRESS: STIEET8102 Skansie Ave <br /> CITY GIG HARBOR STATE WA z,P 98335 <br /> CONTRACTOR PHONE:(5509) 660-3014 1CONTRACTOR EMAIL:jordan.schilling@legacytowers.com <br /> legacytowers.com <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:830_387_6471 <br /> David Baker CONTACT EMAIL:david.baker@enertechresources.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $17,775 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:Apartments <br /> PROPOSED USE OF BUILDING:Apartments <br /> HEAT SOURCE: [-]Gas ❑Electric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU OMulti-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition [-]Remodel [-]Repair ❑T.I. ❑Change of Use <br /> ❑Modular [-]Portable ❑Re-roof ❑Exterior Alteration [-]Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub [-]Tank(above ground) Z10ther:Demo <br /> DESCRIPTION OF WORK:Removal of all print cell site elements Including antennas, microwaves, radios, mounts, <br /> cabling, hardware, equipment cabinets, junction boxes and distribution boxes. <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 1 am authorized by the owner of this property 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 /> 3/7/2023 PERMIT# <br /> Owne uthorized Agent Signature Date (Revised 412112022) <br />