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BLD2021-1248+Application+9.8.2021_1.56.59_PM+2397873CITY OF EDMONDS M BuildingPermit.com Building Application #1016690 - T-Mobile SE01451A Woodway Executive HOA Applicant First Name Last Name Company Name Bryson Burqhardt Smartlink Number Street Apartment or Suite Number E-mail Address 11232 120th Ave Suite 204 bryson.burghardt(b_smartlinkgroup.com City State Zip Phone Number Extension Kirkland WA 98033 3605818189 Contractor Company Name Contractor Unknown Number Street Apartment or Suite Number City State License Number Project Location Number Street 1005 5TH AVE S City EDMONDS Associated Building Permit Number State Zip License Expiration Date Phone Number Extension UBI # E-mail Address Zip Code County Parcel Number 98020 00694700210200 Tenant Name T-Mobile Additional Information (i.e. equipment location or special instructions). Work Location Property Owner Floor Number Suite or Room Number Rooftop and None First Name Last Name or Company Name Susan M Paine Number Street Apartment or Suite Number 1005 5TH AVE S 102B City State Zip EDMONDS WA 98020-4051 Certification Statement - The applicant states: I certify that I am the owner of this property or the owner's authorized agent. If acting as an authorized agent, I further certify that I have full power and authority to file this application and to perform, on behalf of the owner, all acts required to enable the jurisdiction to process and review such application. I have furnished true and correct information. I will comply with all provisions of law and ordinance governing this type of application. If the scope of work requires a licensed contractor to perform the work, the information will be provided prior to permit issuance. Date Submitted: 9/8/2021 Submitted By: Bryson Burghardt Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Building Application #1016690 - T-Mobile SE01451A Woodway Executive HOA Project Contact Company Name: Smartlink Name: Bryson Burghardt Address: 11232 120th Ave Suite 204 Kirkland WA 98033 Project Type Nonresidential Email: bryson.burghardt@smartlinkgroup.com Phone #: 3605818189 Activity Type Remodel Project Name: T-Mobile SE01451A Woodway Executive HOA Description of Work: Modification of wireless communication facility located on a rooftop. Please see project narrative and construction drawings for more detailed information. Project Details Valuation Fair Market Value of Construction Work $45,000 Exterior Changes? The work involves changes to the exterior Page 2 of 2