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BLD2021-1734+Application+12.23.2021_9.52.31_PM+2591513CITY OF EDMONDS Building Application #1061965 - SESEA00426D Applicant First Name Last Name Mike Slotemaker Number Street Apartment or Suite Number 12303 434th Ave SE City State Zip North Bend WA 98045 Contractor Company Name Contractor Unknown Number Street City State Zip State License Number License Expiration Date UBI # Project Location Number Street 410 4TH AVE N City Zip Code EDMONDS 98020 Associated Building Permit Number Additional Information (i.e. equipment location or special instructions). Work Location Property Owner MyBoildingPermit.com Company Name Grey Skies Wireless E-mail Address mike.slotemaker(aD_greyskieswireless.com Phone Number Extension 2062148954 Apartment or Suite Number Phone Number Extension E-mail Address Floor Number Suite or Room Number roof None County Parcel Number 27032400207100 Tenant Name DISH Wireless L.L.C. First Name Last Name or Company Name EDMONDS PUBLIC FACILITIES DISTRICT Number Street Apartment or Suite Number 121 5TH AVE N City State Zip EDMONDS WA 98020 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: 12/23/2021 Submitted By: Mike Slotemaker Page 1 of 2 CITY OF EDMONDS Mysu;laingPerrnit.com Building Application #1061965 - SESEA00426D Project Contact Company Name: Grey Skies Wireless Name: Mike Slotemaker Email: mike.slotemaker@greyskieswireless.com Address: 12303 434th Ave SE Phone #: 2062148954 North Bend WA 98045 Project Type Nonresidential Activity Type Remodel Project Name: SESEA00426D Description of Install six (6) antennas behind existing screening on north and south sides of upper roof, Work: attach three (3) antennas, painted to match, to east wall of upper roof, mount support cabinet and associated cables and cable covers to east wall, all painted to match. Project Details Project Information Square Feet -Tenant 35 Valuation Fair Market Value of Construction Work $90,000 Exterior Changes? The work involves changes to the exterior Page 2 of 2