1020 N BROADWAY DISH WIRELESS COMMUNICATIONS EQUIPMENT 2025-04-24

` B' .DING PERMIT APPLICAT 'N 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)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 1020 N. Broadway Avenue PARCEL#: 29051700203200 CITY Everett STATE WA ZIP 98201 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable):Rooftop Installation TENANT/BUSINESS NAME(if non-residential):Dish Wireless, LLC LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Broadway Property Owner, LLC OWNER MAILING ADDRESS: STREET 10777 West Twain Avenue, Suite 115 CITY Las Vegas STATE NV zip 89135 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME:Modus,LLC cl �-• WA STATE CONTRACTOR LICENSE#(REQUIRED): MODUSL'825NZ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Pending CONTRACTOR ADDRESS: STREET 1614 SE 10th Avenue ow Portland STATE WA ZIP 97214 CONTRACTOR PHONE:(530)913-9577 CONTRACTOR EMAIL: Jstillman@modusllc.com PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) Agent for Applicant, Dish Wireless, LLC(Tenant) CONTACT NAME: CONTACT PHONE: (206) 992-1684. Leslie Bradley/Morrison Hershfield as Agent for DISH Wireless. CONTACT EMAIL: Ibradley@morrisonhershfield.com BUILDING INFORMATION VALUATION OF WORK: $100,000. ASSOCIATED LAND USE PROJECT#(if applicable):REVI122-053 (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:Apartment Building (student houseing) PROPOSED USE OF BUILDING:Apartment Building with a WCF (Wireless Communications Facility) on the rooftop. HEAT SOURCE: ❑Gas ❑Electric ❑✓Other Not applicable BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑✓Multi-Family-#Units:124 ❑✓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:New Wireless Communications Facility DESCRIPTION OF WORK: Dish Wireless is proposing to install a WCF(Wireless Communications Facility) on the rooftop of the subject building (KOZ Apartments) located at 1020 N. Broadway Avenue. The installation will consist of three FRP (Fiberglass Reinforced Panels) that will stealth the antennas and equipment on the rooftop of the building. Once sector will be attached to the existing penthouse, and the panels will be painted to match the facade of the building. The other two sectors will be screened by FRP panels mounted to the roof of the building. The second stealth sector includes an equipment platform that will contain the supporting cabinet and auxilliary equpment to support the cell site. 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 rifNAL: 3/22/2022 PERMIT# Owner/Authorized Agent Si ature Date (Revised 4/21/2022)