1871 ROSS AVE VERIZON ANTENNA 2025-08-18

wpm irm Bl__JDING PERMIT APPLICAT V EVERETT CITY OF EVERETT PERMIT SERVICES 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 l(W)everettwa.gov/ rmits (Blue or Black Ink Only Please) ic$� k PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STRE Ross Ave _ PARCEL#: 29050900300100 CITY Everett STATE WA ZIP 98205 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME (if non-residential):VeriZOn Wireless LEGAL DESCRIPTION for new construction: Short Plat/subdivision: SW1/4 SEC9 T29N R5E I.ot No.:3001 (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Verizon Wireless OWNER MAILING ADDRESS: STREET 3245 158th Ave, MS 231 CITY Bellevue slATE WA zip 98008 OWNER PHONE: ,.( OWNER EMAIL: CONTRACTOR COMPANY NA :TBD— � UST <jOLU7tQA'$ WA STATE CONTRACTOR LIC NSE#(R UIRED)CELLSS7F'! / Ib14' CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6-6 CONTRACTOR ADDRESS: STREET //�� ! j 5 0 C ST C'Y.h'�- (2A,Il� S(� �y�y CITY Q S STATE ZIP 3 L CONTRACTOR PHONE: CONTRACTOR EMAIL: i✓✓/"`^/ 4 PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR n OTHER(Please Specify) Representative CONTACT NAME: CONTACT PHONE:206-604-5538 Mike Unger CONTACT EMAIL:mike.unger@acomconsultinginc.com BUILDING INFORMATION VALUATION OF WO.$20,000 ;/ ASSOCIATED LAND USE PROJECT#(if applicable):NA (Valuation shall include the pre ailing fair marke/alue of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUIL INGuipment shelter PROPOSED USE OF BUILDING:NO change HEAT SOURCE: CiGas ❑Electric L_]OtherNA BUILDING TYPE: USER ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: __ ❑Commercial [lAccessory 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:Add microwave antennas DESCRIPTION OF WORK:Verizon will be installing (2) microwave antennas on (2) rooftop mounts on top of their equipment shelter. There will be no tower or groundwork associated with this project. 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/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 18.2I RCW and 296.200A WAC. City of Everett Official Use Only 5/8/23 P MITlo2_305 6?3 Owner/Authorize Agent Signature Date (Revised 4/21/2022)