9506 19TH AVE SE A T AND T ANTENNA 2025-04-21

1 • • 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 I(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 9506 19th Avenue SE PARCEL#: 28051800401700 cnTY Everett STATE WA zip 98208 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):AT&T LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:CHJ Properties LLC OWNER MAILING ADDRESS: STREET 8215 15th Ave NE tiny Seattle STATE WA zip 98115 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME:TBD':`Seleetien-Riede'-at-tittre of per[nit approval TE L-1 AA;R K WA STATE CONTRACTOR LICENSE#(REQUIRED):t A S eNcs--1 KN CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): A 44-3 CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ElCONTRACTOR Cl 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: ❑✓Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): LiNew Construction ❑Addition ❑Remodel ❑Repair HT.!. ❑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 6 antennas with 6 new antennas. No changes in height proposed. No changes to the number of equipment cabinet proposed. 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 Fu Chang Digitly signed by Fu Chang Date:a12023.02.14 12:31:42 08'00' 3/1 5/23 PERMIT# vh� Owner/Authorized Agent Signature Date (Revised 4/21/2022)