1871 ROSS AVE VERIZON ANTENNA 2018-01-04

• � PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJECT ADDRESS: 'I$7"I ROSS AV2, Everett IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY �C COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? � NO ❑YES, FROM TO NEW WATER/SEWER SERVICE NEEDED? 0 NO ❑ YES,TYPE 51ZE . $�T�WORlC l_RI�MT-OF-WAY APPLIC,M,.*i'�#NFOt�l111�'Tt�t# ; DESCRIPTION OF WORK: (N) 17"x30"x36" deep hand hole to be placed at the private property line near the public right- of way (Smith Island Rd.). (N) 4" conduit to be bored 36"deep from (N) hand hole to the Verizon cell site, approximately 190'. All other work will take place within the Verizon cell site compound. ❑ FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON/CURB CUT FT WIDE ❑ASPHALT/CONCRETE PAVING SF ❑ RETAINING WALL!ROCKERY IN RIGHT-OF-WAY LF ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT ❑CLEARING/GRADING!FILL/EXCAVATE CY �CUT/BORE IN PAVEMENT(PARALLEL) �,qravel) 190� LF ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF CQNTACT' lNF4RMAT1pN ' OWNER NAME: Da mar's Marina OWNER MAILING ADDRESS: sTReeT 1870 Ross Ave �„Y Everett STATE WA Z,P 98201 OWNER PHONE: OWNER EMAIL: APPLICANT NAME: Brynn HOW@C�VIt1CUIU1'11S S@I'VIC@S, on behalf of Verizon Wireless APPLICANT MAILING ADDRESS: srREET 3301 Burke Ave N, Ste. 100 cirv S2attle STATE WA zia 98103 APPLICANT PHONE:206-661-8998 APPLICANT EMAIL: bhOWef q�V111CUlUfi1S.00171 PRIMARY CONTACT: ❑OWNER �APPLICANT ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: 206-661-8998 Brynn Hower CONTACT EMAIL: bhOW2f vinculums.com 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/aw. 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/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 PERMIT# �r r . G �i� l ' �----� �� j � �� PW I �I I-c�o5 OwnerlA� orized Agent Signature Date (Revised 9/23/2016)