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BLD2022-0302+Application+3.9.2022_3.56.57_PM+2728390CITY OF EDMONDS nnyst,ilaingPermit.com Building Application #1105159 - Crown Castle for T-Mobile, 826146 Applicant First Name Last Name Company Name Emilie Deschamps GMA Network Services Number Street Apartment or Suite Number E-mail Address PO Box 2006 City State Bellevue WA Contractor Company Name Contractor Unknown Number Street City State License Number Project Location Emil ie(�D_gmanetworkservices.com Zip Phone Number Extension 98009 8027773358 Number Street 10014 238TH ST SW City EDMONDS Associated Building Permit Number State Zip License Expiration Date Apartment or Suite Number Phone Number Extension UBI # E-mail Address Floor Number Suite or Room Number Ground - CELLULAR Zip Code County Parcel Number 98020 00615800000100 Tenant Name Crown Castle for T-Mobile Additional Information (i.e. equipment location or special instructions). Work Location Property Owner First Name Last Name or Company Name Thomas & Phan Quyen Sawyer Number Street Apartment or Suite Number 1005 196TH PL SW City State Zip LYNNWOOD WA 98036-7188 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: 3/9/2022 Submitted By: Emilie Deschamps Page 1 of 2 CITY OF EDMONDS M BuildingPerrnit.com Building Application #1105159 - Crown Castle for T-Mobile, 826146 Project Contact Company Name: GMA Network Services Name: Emilie Deschamps Email: Emilie@gmanetworkservices.com Address: PO Box 2006 Phone #: 8027773358 Bellevue WA 98009 Project Type Nonresidential Project Name: Crown Castle for T-Mobile, 826146 Activity Type Remodel Minor modifications to the existing Wireless Facility. Tower Scope of Work: -Remove (3) Antennas -Remove (12) Diplexers -Remove (6) TMAs -Remove (1) Concealment Shroud -Install Description of (3) Antennas -Install (6) RRUs -Install (1) HCS 2.0 J-Box w/ Breakout Pendants -Install (1) 1-1/2" Work: Hybrid Cable -Install (1) Expanded Concealment Shroud Ground Scope of Work: -Remove (1) Indoor Rack -Remove (9) RRUs -Install (1) 19" Rack w/: (1) RAYCAP Voltage Booster w/ (3) Amplifiers & (1) CSR IXRE V2 Router -Remove (E) Power Rack -Relocate (E) LEC Router to Wall -Install Delta Elite Power Rack -Install (2) Ladder Racks -Install (2) Vertical Ladder Racks Project Details Valuation Fair Market Value of Construction Work $25,000 Exterior Changes? The work involves changes to the exterior Page 2 of 2