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BLD2014-00329
• Review PERMIT APPLICAtON R 00329 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00329 Received Date: 9/10/2014 SITE ADDRESS: 124 E GO-ONNA DR QUILCENE, 98376 OWNER: VERIZON WIRELESS PHONE: 253-218-9017 RICK CARDOZA 14201 NE 200TH ST. #100 WOODINVILLE WA 98072 9550 SUBDIVISION: Block: Lot: 31 PARCEL NUMBER: 955000031 Section: 27 Township: 26 N Range: 1V1 CONTRACTOR: PRESCO TELECOMMUNTIONS INC PHONE: 206-459-6811 PAUL 32420 148TH AVE SE AUBURN WA 98092 Contractor's License PRESCTI073BN Expires 8/29/2015 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP Cell Tower Remodel- Replace 5 panel antennas, Add 3 RRU's, 2 OVP Distribution Box, 1 Hybrid cable, 3 TMA TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP ADD MAIN: INDUSTRIAL: VALUATION 18,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: NUMBER OF EMPLOYEES: WATER SYSTEM: BATHROOMS: Exist: Prop: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $256.00 SRE 09/08/14 151515 Plan Check $166.40 SRE 09/08/14 151515 '` State Building Code $4.50 SRE 09/08/14 151515 Total: $426.90 �1CC 0 204 fferson County DCD \\tidemark\data\forms\F_BLD_App_Bid.rpt 12/30/2014 ` \ JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT Date: ,., "4 Time Received: 1 qQ am,41.1 Mon. Tue. Wed. Thur. Fri. Date: BLD: //- 32.41 Contact Name: Owner: Contact Number: 360 Address: /01,y 9 6-0f1.aS)A 206 £7`&b 335 Notes: Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection Y Setbacks Floor Foundation Wall Address Posted Block &Tile Ceiling LDC THE CIVIL ENGINEERING GROUP March 23, 2015 omraaer&3a1 ia$rasirut:.0 re Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 Permit Application Number: BLD14-00329 Site Name: Verizon - WA1 Brinnon AWS Site Address: 124 E Go-Onna Drive Quilcene, WA 98376 Property Owner: David E. Ward P.O. Box 123 Quilcene, WA 98376 Parcel Number: 9550000031 Lot: 31 Section/Township/Range: 27/26N/1 W Contractor: Presco Telecommunications Inc. 32420 148th Ave Se Auburn, WA 98092 License Number: PRESCT1073BN Exp: 08-29-15 Dear Jefferson Co. Comm. Dev.: Thank you for reaching out to LDC in responding pertaining to the above project being an existing telecommunications facility undergoing a minor modification. In an effort to ensure the above project is compliant with jurisdictional comments, please note that the architect of record is confirming that the installation was performed as conveyed in the Construction Documents. Thank you for your time in reviewing this project. Please feel free to contact me for any further assistance pertaining to this project at the below contact information. Richard Hall, AIA Washington Reg. Architect # 8828 Senior Architect Exp. 08-20-15 LDC, Inc The Civil Engineering Group 14201 NE 200th St, Ste 100 Woodinville, WA 98072 Mobile.425.802.1219 Office.425.806.1869 Fx.425.482.2893 rhall@ldccorp.com www.LDCcorp.com w z E n g i n eer! n A i i. ()V.._ _,_the._.._S..t a_n d a r d Sally Ellis From: Evan Jones <evan.j @prescotelecom.us> Sent: Monday, March 30, 2015 9:46 AM To: #dcd Subject: Fwd: WA1 Brinnon Letter Confirming Installation_20150323 Attachments: WA1 Brinnon Letter Confirming Installation_20150323.pdf Good morning. This is Evan Jones with Presco Telecommunications. I am writing in regards to building permit number BLD14-00329. This is for a Verizon Wireless communications facility. Attached is the letter from the architect stating the job is completed correctly. I would like to get the final sign off on this BP. If you could please, scan the "final sign off card" and email it back to me at Evan.J @PrescoTelecom.us Let me know if there's anything else you may need from me or if you have any questions. Thank you. Forwarded message From: Evan Jones <evan.j @prescotelecom.us> Date: Tue, Mar 24, 2015 at 8:01 AM Subject: Re: WA1 Brinnon Letter Confirming Installation 20150323 To: Richard Hall <rhall @ldccorp.com> Cc: Elizabeth Goodnow<egoodnow @ldccorp.com>, Luke Sprague <luke.s@prescotelecom.us>, Richard Cardoza<rcardoza@ldccorp.com> Thank you very much everyone!!! On Tue, Mar 24, 2015 at 7:54 AM, Richard Hall <rhall @ldccorp.com>wrote: Hello Elizabeth & Evan: Please find attached, "WA1 Brinnon Letter Confirming Installation_20150323", to be issued to Jefferson Co. • Thanks, Richard Hall,AlA Senior Architect LDC, Inc The t ivil Erv., neei ire F; o 'k: Mobite,425.802.1219 1 Office.425.806.1869 Fx.425.482.2893 14201 NE 200th St, Ste 100 Woodinvitte, WA 98072 rhall @ldccorp.corn www.LDCcorp.com "Engineering ABOVE the Standard„ From: Elizabeth Goodnow Sent: Friday, March 06, 2015 7:24 AM To: Richard Hall Cc: Evan Jones; Luke Sprague; Richard Cardoza Subject: FW: VZW Cell Site WAl-Brinnon 3rd party review request for Building Permit Approval Hi Rich, Thanks for talking with me this morning about the WA1 Brinnon AWS project. As we discussed, Evan Jones needs a letter addressed to Jefferson County confirming that the installation was done as directed by the CDs you signed. If you have any further questions or need more photos, please email Evan. Thank you, Rich. Best wishes, Elizabeth Goodnow Proje€, Mono/- LDC, Inc The Civil Engineering Group Ph.425.806.1869 Fx.425.482.2893 2 Cell 206.379.1269 14201 NE 200th St, Ste 100 Woodinville, WA 98072 www.LOCcorp.com "Engineering ABOVE the Standard" From: Evan Jones [mailto:evan.j @brescotelecom.us] Sent: Thursday, March 05, 2015 10:09 AM To: Elizabeth Goodnow Cc: Luke Sprague Subject: VZW Cell Site WA1-Brinnon 3rd party review request for Building Permit Approval Good morning Elizabeth. Thank you for helping me with this. According to the building permit with Jefferson County, we need a letter from the engineer who drew up the construction drawings stating that the job was done correctly sent over to Jefferson County Building Division. Attached are the BP copy, some onsite photos & the construction drawings (within the AWS Handover package). Please let me know if you have any questions or concerns. Thank you very much. Regards, Evan Jones Presco Telecommunications evan.j@prescotelecom.us 14831 SE 324th St Auburn, WA 98092 Office: 253-833-8088 Fax: 253-833-3590 Mobile: 206-817-8013 3 Regards, Evan Jones Presco Telecommunications evan.j@prescotelecom.us 14831 SE 324th St Auburn, WA 98092 Office: 253-833-8088 Fax: 253-833-3590 Mobile: 206-817-8013 Regards, Evan Jones Presco Telecommunications evan.j@prescotelecom.us 14831 SE 324th St Auburn, WA 98092 Office: 253-833-8088 Fax: 253-833-3590 Mobile: 206-817-8013 4 • • L DC THE CIVIL ENGINEERING GROUP March 23, 2015 ommt'rs.i Inn rte Inre Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 Permit Application Number: BLD14-00329 Site Name: Verizon - WA1 Brinnon AWS Site Address: 124 E Go-Onna Drive Quilcene, WA 98376 Property Owner: David E. Ward P.O. Box 123 Quilcene, WA 98376 Parcel Number: 9550000031 Lot: 31 Section/Township/Range: 27/26N/1W Contractor: Presco Telecommunications Inc. 32420 148th Ave Se Auburn, WA 98092 License Number: PRESCT1073BN Exp: 08-29-15 N V Dear Jefferson Co. Comm. Dev.: Thank you for reaching out to LDC in responding pertaining to the above project being an existing telecommunications facility undergoing a minor modification. In an effort to ensure the above project is compliant with jurisdictional comments, please note that the architect of record is confirming that the installation was performed as conveyed in the Construction Documents. Thank you for your time in reviewing this project. Please feel free to contact me for any s further assistance pertaining to this project at the below contact information. Richard Hall, AIA Washington Reg. Architect # 8828 Senior Architect Exp. 08-20-15 LDC, Inc The Civil Engineering Group 14201 NE 200th St, Ste 100 2 Woodinville, WA 98072 '; Mobi le.425.802.1219 Office.425.806.1869 Fx.425.482.2893 rhall@ldccorp.com www.LDCcorp.com z • EngineerinJLABOVE= the Standard • Sally Ellis From: Evan Jones <evan.j @prescotelecom.us> Sent: Monday, March 30, 2015 9:46 AM To: #dcd Subject: Fwd: WA1 Brinnon Letter Confirming Installation_20150323 Attachments: WA1 Brinnon Letter Confirming Installation_20150323.pdf Good morning. This is Evan Jones with Presco Telecommunications. I am writing in regards to building permit number BLD14-00329. This is for a Verizon Wireless communications facility. Attached is the letter from the architect stating the job is completed correctly. I would like to get the final sign off on this BP. If you could please, scan the "final sign off card" and email it back to me at Evan.J @PrescoTelecom.us Let me know if there's anything else you may need from me or if you have any questions. Thank you. Forwarded message From: Evan Jones <evan.j @prescotelecom.us> Date: Tue, Mar 24, 2015 at 8:01 AM Subject: Re: WA1 Brinnon Letter Confirming Installation 20150323 To: Richard Hall <rhall @ldccorp.com> Cc: Elizabeth Goodnow<egoodnow @ldccorp.com>, Luke Sprague <luke.s@prescotelecom.us>, Richard Cardoza<rcardoza@ldccorp.com> Thank you very much everyone!!! On Tue, Mar 24, 2015 at 7:54 AM, Richard Hall <rhall @ldccorp.com> wrote: Hello Elizabeth & Evan: Please find attached, "WA1 Brinnon Letter Confirming Installation_20150323", to be issued to Jefferson Co. Thanks, Richard Hall, AIA Senior Ai(hi:e LDC, Inc The Civil Engineering Group Mobile A25.802.1219 1 Office.425.806.1869 Fx.425.482.2893 • 14201 NE 200th St, Ste 100 Woodinville, WA 98072 rhall @ldccorp.corn www.LOCcorp.corn "Engineering ABOVE the Standard„ From: Elizabeth Goodnow Sent: Friday, March 06, 2015 7:24 AM To: Richard Hall Cc: Evan Jones; Luke Sprague; Richard Cardoza Subject: FW: VZW Cell Site WA1-Brinnon 3rd party review request for Building Permit Approval Hi Rich, Thanks for talking with me this morning about the WA1 Brinnon AWS project.As we discussed, Evan Jones needs a letter addressed to Jefferson County confirming that the installation was done as directed by the CDs you signed. If you have any further questions or need more photos, please email Evan. Thank you, Rich. Best wishes, Elizabeth Goodnow Project Manager LDC, Inc rt& C wit Engineer r s s 'Group Ph.425.806.1869 Fx,425.482.2893 2 Cett 206.379.1269 • 41111 14201 NE 200th St, Ste 100 Woodinvitte, WA 98072 www,LDCcorp.corn "Engineering ABOVE the Standard" From: Evan Jones [mailto:evan.j@prescotelecom.us] Sent: Thursday, March 05, 2015 10:09 AM To: Elizabeth Goodnow Cc: Luke Sprague Subject: VZW Cell Site WA1-Brinnon 3rd party review request for Building Permit Approval Good morning Elizabeth. Thank you for helping me with this. According to the building permit with Jefferson County, we need a letter from the engineer who drew up the construction drawings stating that the job was done correctly sent over to Jefferson County Building Division. Attached are the BP copy, some onsite photos &the construction drawings (within the AWS Handover package). Please let me know if you have any questions or concerns. Thank you very much. Regards, Evan Jones Presco Telecommunications evan.j@prescotelecom.us 14831 SE 324th St Auburn, WA 98092 Office: 253-833-8088 Fax: 253-833-3590 Mobile: 206-817-8013 3 • • Regards, Evan Jones Presco Telecommunications evan.j@prescotelecom.us 14831 SE 324th St Auburn, WA 98092 Office: 253-833-8088 Fax: 253-833-3590 Mobile: 206-817-8013 Regards, Evan Jones Presco Telecommunications evan.j@prescotelecom.us 14831 SE 324th St Auburn, WA 98092 Office: 253-833-8088 Fax: 253-833-3590 Mobile: 206-817-8013 4 N r N 00 (n— ° MA -n y K ∎= 0 M M r 0 m m a 0MW< "C r M C '- M. J- ,j aaz acnzmCI) LI Z <m m> 0 02 j,0 Z0 lb Z<A 0.Z7 j,CC, e• i y Z C H°aT) J 0 2 u)cr) Z = cn m m mm�a M SSm _ <A CCn2 Ill u 0 K>Z a 0av 0 Z N° m <np0m 2 n a° a-i u) I 0 ... (E) PROPERTY LINE - 301.72' --1 1 C zi>� II p X I�, Z Z t � I 289t TOWER SETBACK '. O /r$` — C a y W cn N (E) PROPERTY LINE - 301.73' m m + • -°0'�����.-ice.®.m®®®.>,� m x X0 0 z(7, Z 1z ° n_., G) A m O N °Z - 0 =i 5_°0 0< m Z il O 0 m pc0 zz m z -•m m 47 d f ti)<.,. t` cn. m cn ` t z xY Hf 8o z z T. ''`` ii'' y a �� 0 v - o °'� rp r g p b . 1 v I � 'b nm (T \{V\ O -n Z C') 00 G7 0 0 mC N CD TRUE NORTH 1 -p rri 461°40c µ Z ,0 D _ o' rift p A p m 4 FI77 m ;g - z V) r0 >2 7 n r-'''' .17 O { m m m0 a 20 M� o ; < W �a m m z0 m $ p o N8 z v � mz .1; :7; 3 �a z m 0 am E i p ? 0 --) a CO z x 1,1 Z ii CO zr m 0 i - ct 3 :� ma M W Z 7 N N4 yen on wireless N N C °)O Zl N &$ m = K 'A BE A ,i i qlka Front Parcel Review '170 /2/-003 Parcel 955000031 Printed: September 12, 2014 Site Address(es): DAVID E WARD 124 E GO-ONNA DR QUILCENE, WA 98376 PO BOX 123 QUILCENE, WA 98376-0123 Parcel Number: 955000031 S-T-R: 27-26N-1W Total Acreage 1 Legal Description GO-ONNA BEACH TR DIV 2 LOT 31 Land Use: 9100 Flood District: Fire District: 2 Planning Area: Flood Map(FIRM)Panel No: School District 48 Zoning: J S� COMP PLAN DESIGNATION: COMMUNITY PLAN: UGA: UGA Trans [ ] Plot plan states "property line" [ ] Assessor's Map (Property lines on submitted plot plan must match the property lines as identified on the Assessor's 1/4 map) [ ] Legal Access to Property YES NO [ ] Parcel Tags or Scanned Documents Y.,S NO ,ilo 6y,e c_,cAA [ ] ESA's: Special Reports Nearby YES - [ ] Designated Ag YES [ ] Shoreline Designation: YES N�--- [ ] Shoreline Slope Stability: YES _ND_ Stream Type:YES >0- FWHCA: YES l�Q- Wetlands: YES N�c Rare Plants:YES 12-- Seismic: YES 1 ' Landslide: YES Flood: YES Erosion: YES Aquifer Recharge Area:YES NQ✓ SIPZ: n At Risk High Risk Coastal CMZ: High Risk Moderate RiskDisconnected CMZ Stormwater site plan submitted: YesNo [ ] Forest Lands: YES �I Adjoining Forest Lands: Commercial/ Rural/ Inholding --- [ ] Mineral Lands: YES �t 13-- [ ] Agricultural Lands: YES [ ] Archaeology: YES rNCy No Shooting Zone: Y o .C-L, [ ] g NO c' f 'S � [ Stormwater: New Impervious Surface 0 La nd Disturbing Activity � ESA s t rmwater Re 's:Min Re #2 Min Re #1 thru#5 Min Re #1 thru#10 Engineering So 9 9 g g q q [ ] Notice Provisions/Disclosure:Airport YEs 66? MRL YES 6 Forest Lands YES CO [ ] Landscaping Required: Yes [ ] Parking Spaces Required ^ 2 Other 1 l Building Heieht: 35' UBC Standard VA- [ ] Impervious Surface coverag centage: /7,7 , Resource Lands&Public: 10°/oNir Rural Residential: 25% Rural Indust er UDC Sec 6.7 Rural Commercial: 60% Area of Building Coverage:60%in Rural Industria Lands only [ ] Total Building (s) Size: u/'k RVC:20,000 SF CC: 5,000 SF NC: 7,500 SF GC: 10,000 SF All others:subject to septic&water constraints/None specified [ ] Setbacks: Front: Left Side: ' Right Side: - Rear: `a Shoreline Setback:LSHA Setback: [ ] Road Classification: L ccr...( A c r_c ( C _ Road Approach: EXISTING NOT REQ'D RAP [ ] SEPA Required: YES ExENE.T [ ] Flood Certificate: [ ] Existing Case(s) & Condition(s): Violations: Yes No [ ] Recorded Date of Subdivision: AFN Over 5yrs=UDC Plat Conditions: <5yrs=Plat Conditions on plat or Old Ordinance [ ] Lots/Require Declaration of Restrictive Covenant YES NO, submitted: YES NO [ ] UGA No Protest Agreement YES NO, submitted: YES NO [ ] Site Visit conducted YES NO [ ] Require Final Zoning Approval YES NO [ ] ADMIN: Setbacks entered in Permit Plan case N/A YES New Parcel Tags entered in Permit Plan N/A YES Special Reports Scanned N/A YES Title Notes Updated Parcel tags found for parcel 955000031 1.) Custom Warning Flag ZON04-00026 Acoustical Report. See Laserfiche or 05/08/2007 MLA04-00241 for full report. Parcel tags found for parcel 955000031 2.) WSRC Coaching - 2012-02-09, SG 09/05/2013 Other Parcel tags found for parcel 955000031 3.) WSRC Coaching - 2012-10-29, CZ 11/06/2013 Other Parcel tags found for parcel 955000031 4.) Customer Assistance CAM 11-00049 15 min CJZ 01/24/2014 Mtg Req Cases Associated with APN 955000031 Review Cases Name Type Status Planner BLD14-00003 WILSON I A Donna Frostholm Application Received: 1/6/2014 Permit Issued/Case closed: 2/25/2014 Case Finaled: Modification to existing unmanned cell tower BLD14-00142 WILSON I A Zoe Ann Lamp Application Received: 4/23/2014 Permit Issued/Case closed: 5/2/2014 Case Finaled: Add (1) microwave dish to existing antenna array on existing lattice tower BLD14-00316 LYNX CONSULTING INC P Anna Bausher Application Received: 8/29/2014 Permit Issued/Case closed: Case Finaled: Replace 3 existing stand-off arms with 3 proposed sector frames and add 3 panal antennas, Add 2 RRG's and 6 junction cylinders, 3 filters and 1 expansion cabnit There will be no ground disturbance or grading associated with this proposal. BLD14-00329 DAVID WARD P Application Received: 9/10/2014 Permit Issued/Case closed: Case Finaled: Cell Tower Remodel- Replace 5 panel antennas, Add 3 RRU's, 2 OVP Distribution Box, 1 Hybrid cable, 3 TMA BLD94-00460 US WEST NEWVECTOR GROUF F Application Received: 7/11/1994 Permit Issued/Case closed: 9/27/1994 Case Finaled: 1/25/1995 150 ft cellular communications tower w/12'x 12' equipment bldg \\tidemark\data\forms\R_Parcel_CRMLA.rpt 9/12/2014 Page 2 of 4 BLD99-00579 SPRINT SPECTRUM F Application Received: 8/27/1999 Perm ssued/Case closed: 12/30/1999 Ca inaled: 7/3/2002 minor telecommunications equiped at 118' level of existing 150' lattice tower COM96-00008 US WEST NEWVECTOR GROUF F Application Received: 5/1/1996 Permit Issued/Case closed: Case Finaled: 12/16/1996 Pile driving activity observed on the cleared parcel for most of the day on April 30, 1996. PRE99-00037 US WEST WIRELESS F J SMITH Application Received: 8/10/1999 Permit Issued/Case closed: 8/27/1999 Case Finaled: To co-locate a wireless facility on an existing wireless facility. ZON99-00033 US WEST WIRELESS F J SMITH Application Received: 8/27/1999 Permit Issued/Case closed: 12/9/1999 Case Finaled: 1/7/2002 To co-locate a wireless communication facility on an existing 150 feet high telecommunications tower. CAM14-00049 WILSON NA M Colleen Zmolek Application Received: 1/23/2014 Permit Issued/Case closed: 1/23/2014 Case Finaled: ZONING? PROCESS"I 0 NEPACE EXISTING CELL TOWER COM00-00054 WILSON F Application Received: 3/11/2002 Permit Issued/Case closed: Case Finaled: 5/6/2002 Tower and generator without proper EPA approval? Disel generator is running 24 hours a day next to complaintants house. IZA94-00040 US WEST NEWVECTOR GROUF F Application Received: 6/28/1994 Permit Issued/Case closed: 9/19/1994 Case Finaled: 5/6/2002 to construct a cellular communications facility on a vacant residential lot located on East Go-Onna Dr on the Toandos Peninsula. The site will contain a 150 ft steel self-supporting lattic towner and a 12 ft x 12 ft pre-fabricated equipment building containing radios which control the cellular telephone system. M LA02-00174 BLD02-00187 MLA02-00174 WILSON &VEDA WILSON I F J SMITH Application Received: 4/5/2002 Permit Issued/Case closed: 5/10/2002 Case Finaled: 5/8/2008 12 ft. by 12 ft. ADDITION I U EXISTING COMMERCIAL EQUIPMENT SHEL1 ER SERVING WII"(ELESS COMMUNICATION FACILITIES M LA04-00241 BLD04-00283 MLA04-00241 WILSON II F Stacie Hoskins Application Received: 4/30/2004 Permit Issued/Case closed: 6/10/2005 Case Finaled: 5/8/2008 CO-LOCATION ON EXISTING WIRELESS TELECOMMUNICATION 1-ACILITY AND EQUIPMENT BUILDING PRJ04-00112 MLA04-00241 WILSON P Application Received: 5/3/2004 Permit Issued/Case closed: Case Finaled: Co-locate additional antennas & equipment to (e) WCF ZON04-00026 MLA04-00241 T-MOBILE -VOICESTREAM PC II F Stacie Hoskins Application Received: 5/3/2004 Permit Issued/Case closed: 6/7/2005 Case Finaled: 8/31/2011 T-Mobile USA, dba VoiceStream PCS III, Corporation proposes to co-locate onto an existing wireless telecommunication facility. The proposed facility would consist of a 3-sector array with 2 antennas per sector, for a total of 6 antennas mounted on the existing tower. Associated ground equipment is proposed near the base of the tower within the existing fenced communication equipment compound. The original tower was permitted by Jefferson County in 1994 (IZA94-00040). MLA07-00085 BLD07-00072 MLA07-00085 VERIZON WIRELESS II F Zoe Ann Lamp Application Received: 2/23/2007 Permit Issued/Case closed: 6/19/2007 Case Finaled: 8/7/2008 REMOVE 2 EXISTING ANTENNAS &ADD 12 ANTENNAS TO LATTICE TOWER PRJ07-00032 MLA07-00085 WILSON P Application Received: 3/1/2007 Permit Issued/Case closed: Case Finaled: REMOVE 2 EXISTING ANTENNAS &ADD 12 ANTENNAS TO LATTICE TOWER ZON07-00017 MLA07-00085 VERIZON WIRELESS II A Zoe Ann Lamp Application Received: 2/23/2007 Permit Issued/Case closed: 6/19/2007 Case Finaled: Verizon Wireless proposes to remove two (2) existing omni antennas and add twelve (12) panel antennas to the existing lattice telecommunications tower located at 124 E. Go-onna Dr., Quilcene. The proposal does not include new ground equipment. The antennas and mounts will be painted to match the existing structure. The proposed antennas will be lower than the existing antennas. The original tower was permitted by Jefferson County in 1994 (IZA94-00040). This proposal requires a Type II Conditional Administrative Use permit with public notice. State and local agencies have been asked to review and comment on the proposal. Review under the State Environmental Policy Act(SEPA) is required per WAC 197-11-800(25). MLA12-00233 \\tidemark\data\forms\R_Parcel_CRMLA.rpt 9/12/2014 Page 3 of 4 BLD12-00333 MLA12-00233 VERIZON WIRELESS F Zoe Ann Lamp Application Received: 10/22/2012 Permi Issued/Case closed: 12/26/2012 Cas inaled: 1/2/2014 Building Permit with SEPA: I he proposal is to install a new four(4) foot diameter microwave dish at a height of 127 feet (antenna centerline) on an existing 147' 6" lattice tower. The subject parcel is zoned Rural Residential 1:5 and the size of the new microwave dish is over the size for a microcell as defined in SEPA under WAC 197-11-800(25). As a result, the proposal required review under the State Environmental Policy Act. MLA12-00234 BLD12-00334 MLA12-00234 VERIZON WIRELESS I F Lisa Keller Application Received: 10/22/2012 Permit Issued/Case closed: 11/6/2012 Case Finaled: 4/16/2013 REPLACE 6 PANEL ANTENNAS ON EXISTING TOWER PRE06-00057 REALCOM ASSOCIATES F Zoe Ann Lamp Application Received: 11/21/2006 Permit Issued/Case closed: 12/5/2006 Case Finaled: Modify existing facility by removing two existing omni antennas and adding three sectors consisting of four panel antennas eeach (total of twelve panel antennas) on an existing wireless telecommunication tower. \\tidemark\data\forms\R_Parcel_CRMLA.rpt 9/12/2014 Page 4 of 4 N N (w v, OOU-0 0) X.. y �3m0C A n m mmom� N D c A nm r- > 2- c D�Z m 0 -,z n n m N 0 0 O Qcn-m-1Z Z. mc�'v...... o��c 3 D 0 D03C x- --..1 Zmumm1 x �TND Om _ m m 0 3 D Z A o Z Z N o 2N0-I 1— c6pm =po 5. m coA -4K00 D-I K cn l _ _ _ (E) PROPERTY LINE - 301.72' m µ o 1 O 7J 21:71 ni i ,� m, o Z�Tfi 4 W .a. I I 0 ,:�- n,.I x 1 O ! 2 y6 s c 289't TOWER SETBACK 1. (1 ..''''. (f) PROPERTY LINE - 301.73' rn G'- M N / M + r® X CU 0 03 O x7 xXI tngm mm cn v0o Zx –1 O zm 0 0 A m CD 0 Z -cn G) --i i00 0< m s Z< -u D m x o ri o Axn co m cn p z z cn -1z 0 Tn 0 A M m m o p q ti cn cn cn mD rz m� M Z Z D n T r- CO m -0 z o z n C° C=::1 o Q z r---, O -1 TRUE NORTH 41400c 3; Fl- .i ,,,,,,©11U 0 0 0 Ft 2 om 111111 � 2Di " � n > m m s A z 4 2 in r0 >p 7 0 m m m o -i m m m m U' *� P" 0 8 m m z m m� O gzo m A wn z 4 r -AA P. .,I.:, r, J= - g • e on wireless 03 0!P O N 0 S . c m • • Sally Ellis From: Evan Jones <evan.j @prescotelecom.us> Sent: Monday, December 22, 2014 3:14 PM To: Sally Ellis Subject: Verizon Wireless Building Permit#BLD14-329 Hello, this is Evan Jones with Presco Telecommunications. Thank you for your help with this. Here's our license info: Contractor's License#: PRESCTIO73BN If you could please, scan the BP Inspection card and reply to this email with that attached. To mail the full physical BP and prints, you can send it to the address below. Thanks again for your help and have a great holiday! Regards, Evan Jones Presco Telecommunications evan.j@prescotelecom.us 14831 SE 324th St Auburn, WA 98092 Office: 253-833-8088 Fax: 253-833-3590 Mobile: 206-817-8013 1 PRESCO TELECOMMUNICATIONSINC Page 1 of 3 S 1C) Washington State Department of Labor & Industries PRESCO TELECOMMUNICATIONS INC Owner or tradesperson 14831 SE 324th Street PRESTON, MICHAEL ALAN AUBURN, WA 98092 253-833-8088 Principals KING County PRESTON, MICHAEL ALAN, PRESIDENT PRESTON, NICHELLE LYNNETTE, VICE PRESIDENT Doing business as PRESCO TELECOMMUNICATIONS INC WA UBI No. Business type 601 428 165 Corporation License Verify the contractor's active registration/license/certification (depending on trade) and any past violations. Construction Contractor Active. Meets current requirements. License specialties GENERAL License no. PRESCTI073BN Effective—expiration 01/15/1993—09/10/2015 Bond CBIC $12,000.00 Bond account no. 660576 Received by L&I Effective date 09/10/2001 08/29/2001 Expiration date Until Canceled Insurance Alaska National Insurance Co $1,000,000.00 Policy no. 14HLS31099 Received by L&I Effective date 08/25/2014 08/29/2014 Expiration date 08/29/2015 https://secure.lni.wa.gov/verify/Detail.aspx?UBI=601428165&LIC=PRESCTIO73BN&SAW= 12/30/2014 PRESCO TELECOMMUNICATIO4INC Page 2 of 3 Insurance history • Savings No savings accounts during the previous 6 year period. Lawsuits against the bond or savings No lawsuits against the bond or savings accounts during the previous 6 year period. L&I Tax debts . . ................... .._... No L&I tax debts are recorded for this contractor license during the previous 6 year period, but some debts may be recorded by other agencies. License Violations No license violations during the previous 6 year period. IWorkers' comp Do you know if the business has employees? If so, verify the business is up-to-date on workers' comp premiums. L&I Account ID Account is current. 834,904-00 Doing business as PRESCO TELECOMMUNICATIONS INC Estimated workers reported Quarter 3 of Year 2014"21 to 30 Workers" L&I account representative TO/CAROLYN CRAWFORD(360)902-4715 -Email: CRAI235 @Ini.wa.gov Workplace safety and health Check for any past safety and health violations found on jobsites this business was responsible for. Citation issue date 03/13/2014 No violations Inspection no. 316964659 Location 5309 E. 3rd Ave. Spokane,WA 99212 Citation issue date 09/10/2010 No violations Inspection no. 314493396 Location 10611 18th Ave E Tacoma,WA 98445 Citation issue date 04/09/2009 Violations Inspection no. 313038481 Location https://secure.lni.wa.gov/verify/Detail.aspx?UBI=601428165&LIC=PRESCTI073BN&SAW= 12/30/2014 PRESCO TELECOMMUNICATIONS INC Page 3 of 3 204 S Federal Way • Federal Way,WA 98031 0 Washington State Dept.of Labor&Industries.Use of this site is subject to the laws of the state of Washington. ACCE'ss Waahi ngtflii`' https://secure.lni.wa.gov/verify/Detail.aspx?UBI=601428165&LIC=PRESCTI073BN&SAW= 12/30/2014 • 11 Sally Ellis From: Sally Ellis Sent: Friday, September 19, 2014 2:51 PM To: 'rcardoza @Idccorp.com' Subject: Building permit for site address# 124 E. Go Onna Beach Dr. Quilcene Good afternoon Rick, Please note that we are close to issuing the permit you submitted to our office on 9/8/14. Before I can issue the permit I need to have the contractor information for this permit. I also will need a Fed-ex or UPS label with your account information to mail this permit to your attention once it has been issued. Please advise the contractor for this permit and advise what mailing address you wish for me to mail the approved permit too. If you have any questions or need more information please feel free to contact me. Thank you Sally L Ellis Jefferson County Community Development Permit Technician 621 Sheridan St. Port Townsend, WA 98368 360-379-4452 '' G ICI sellis@co.jefferson.wa.us cut- J6/ t Yiw cz u LOO - k2 (O40 c-bi-' tog toes C;') _ ??-11 vim.. ►\1 CO-A ,rA( 4.-Y-- -11\e\s_a \\er'et— \01 °\ 0\443/' \S\ • ham. \01 • &‘ 1 • Sally Ellis From: Sally Ellis Sent: Wednesday, September 24, 2014 3:12 PM To: 'rcardoza@ldccorp.com' Subject: BLD14-00329 Hello Rick This is Sally with Jefferson County Community Development, I just left you two voicemails today- regarding the Permit BLD14-00329 124 E Go Onna Beach Drive. Quilcene, WA As I discussed in the voicemail-this permit is ready to be issued once we receive the contractor information from you and I confirm that contractor with the Department of L& I. As soon as you give me that information I will then be able to issue the new building permit. Also please advise if you wish for this approved permit to be mailed to your office 14201 NW 200th St#100 Woodinville, WA 98072 Attn: Rick Cardoza Thank you Sally L Ellis Jefferson County Community Development Permit Technician 621 Sheridan St. Port Townsend,WA 98368 360-379-4452 sellis@cojefferson.wa.us 1 0. `,��� JEFFQoN COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT �r 621 Sheridan Street I Port Townsend,WA 98368 I Web:www.co.iefferson.wa.ns/communitydevelopment -18"f/'N Tel:360.379.44501 Fax:360.379.44511 Email:dcd@co.jefferson.wa.us Building Permits&Inspections J Development Consistency Reviews Long Range Planning I Watershed Stewardship Resource Center Master Permit Application MLA: Project Description(include separate sheets as necessary): Please see attached. Replace (5) Panel Antennas. Add: (3) RRUs, (2)OVP Distribution Boxes, (1) Hybrid Cable, (3)TMAs Tax Parcel Number: 955000031 Property Size:22,204.92 sq ft (acres/square feet) Site Address and/or Directions to Property: 124 E. Go Onna Beach Drive, Quilcene, rv' 1810 eda Wilson D V Property Owner(s)of Record: .__.__ _ _ ________ _ _______ Telephone: Fax: Bail: (•' Mailing Address: PO Box 123, Quilcene, WA 98376 Applicant/Agent(if different from owner): Verizon Wireless do Rick Cardoza • Telephone: 253-218-9017 Fax: 425-482-2893 email rrc'�rc ozaMdceoro coma, Mailing Address: 14201 NE 200th ST#100,Woodinville,WA 98072 What kind of Permit?(Check each box that applies ❑ Lot or Road Segregation ❑Building ❑ Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑Single Family ❑ Garage Attached/Detached ❑ Conditional Use[C(a), C(d),or C]** ❑ Manufactured Home ❑ Modular ❑ Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑Special Use(Essential Public Facilities)** ❑ Change of Use ❑ Boundary Line Adjustment ❑ Address ❑ Road Approach ❑Short Plat** ❑ Home Business ❑Cottage Industry ❑ Binding Site Plan** ❑ Propane ❑ Long Plat** ❑Sign ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes" Use Consistency Analysis ❑ Plat Vacation/Alteration** ❑Stormwater Management ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Substantial Development** ❑Temporary Use ❑ Shoreline Management Variance ®Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference ❑ Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal,if known: Q DESIGNATION OF AGENT I hereby designate IR t C4‹ CAC- Z to act as my agent in matters relating to this application for permit(s). OV tIJF -atefd*TURE • ,�i Ef_ Date: j By signing this application form,the ww+er/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attomey's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any r-a uired la er inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applica— t '. • he want rior notice. at /� Signature: want Date: // The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfers a onsibility fo adhering to and complying with the ESA. The Applicant has read this disclaimer tyl sigps and dates it below. Signature: Date: /% / 14 07/24/2013 BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED' IOM INSTALLER: TBD PHONE: FAX: i—o1E'QG/E2—i 1 1,1 2,Gl ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New i Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System X Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# L' Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well H Two Party Type of Heat: Proposed: ❑ Public Total: Name of System: If this is a Commercial Project you mus ans er the following; N/A Number of Parking Spaces: Current: roposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,emp oyees,etc) Current Current Proposed IBC Occupancy: '9 2- IBC Type of construction: t% D Will you have Food Service? Yes / If this is a Propane Tank and/or Appliance Installation hermit.mark all items below that annly: N/A Underground Tank Above ground tank Size of Propane Tank: Heat Stove Cook Stove Woodstove Fireplace .nsert rehtO I evotS telleP i knaT retaW toH i Js this appliance beina installed in a Manufactured/Mobile Home? Yes / When applying for a permit to install a propane tank you must also submit site plan showing all of the buildings,all property lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: 2"O Floor Heated Consistency Review: Lc, Other Heated Base fee: (91.,2*o Mezzanine Additional Section: IC( . aa Heated Basement Plan Check fee: 1tL2 . � Unheated Basement State Surcharge fee: U e Other Unheated Pot Water Review fee: i Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: 47-3..c1 Other TOTAL: $ 7 3 cw 1 Receipt Number: 1 SI 5■ 5 Cash/Check Number: C _� CV I . 35.�A ESTIMATED COST(REQUIRED) Date: �� •Fair market value of all labor and materials foundation to finish $18,000 Initials: 07/24/2013 • • HAVE 4.i) ON °a. JEFFERSON COUNTY J�� _ k SEP 8 2014 ti DEPARTMENT OF COMMUNITY DEVELOPMEN I JEFFERSON COUNTY 621 Sheridan Street • Port Townsend • Washington 98$68 1,9 360/379-4450 . 360/379-4451 Fax __DEPT OF COMMUNITY DEVELOPMENT http://www.co.jefferson.wa.us/commdevelopment/ Stormwater Calculation Worksheet MLA# PROJECT/APPLICANT NAME: WA1 Brinnon DETERMINING STORMWATER MANAGEMENT REQUIREMENTS: This stormwater calculation worksheet should be completed first to classify the proposal as"small,""medium,"or"large." The size determines whether a Stormwater Site Plan is required in conjunction with a stand-alone stormwater management permit application, building permit application, or other land use approval application that involves stormwater review. The basic information will also be helpful for completing a Stormwater Site Plan, if required. PARCEL SIZE(I.E.,SITE) Size of parcel 0.51 acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet 22,204.92 sq/ft Land-disturbing activity is any activity that results in movement of earth, or a change in the existing soil cover(both vegetative and non-vegetative) and/or the existing soil topography. Land disturbing activities include, but are not limited to clearing, grading, filling, excavation, and compaction associated with stabilization of structures and road construction. Native vegetation is vegetation comprised on plant species,other than noxious weeds,that are indigenous to the coastal region of the Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include species such as Douglas fir,western hemlock,western red cedar,alder,big-leaf maple,and vine maple;shrubs such as willow,elderberry, salmonberry, and salal;herbaceous plants such as sword fern,foam flower,and fireweed. LAND DISTURBING ACTIVITY,CONVERSION OF NATIVE VEGETATION,AND VOLUME OF CUT/FILL Calculate the total area to be cleared, graded,filled, Answer the following two questions related to excavated,and/or compacted for proposed development conversion of native vegetation: project. Include in this calculation the area to be cleared for: Does the project convert 3/4 acres or more of Construction site for structures NSA sq/ft native vegetation to lawn or landscaped areas? Drainfield,septic tank,etc. N/A sq/ft Circle: Yes 0 Well,utilities,etc. N/A sq/ft Does the project convert 2 1/2 acres or more of native vegetation to pasture? Driveway, parking, roads,etc. N/A sq/ft Circle: Yes No Lawn, landscaping, etc. N/A sq/ft Other compacted surface, etc. N/A sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance ZERO sq/ft Cut ZERO Fill ZERO (cu/yd) [over] stormwater calc worksheet—REV.2/20/2008 1 • • Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural conditions prior to development. A hard surface area which causes water to run off the surface in greater quantities or at an increased rate of flow from the flow present under natural conditions prior to development. Common impervious surfaces include, but are not limited to roof tops, walkways, patios, driveways, parking lots or storage areas, concrete or asphalt paving, gravel roads, packed earthen materials, and oiled, macadam or other surfaces which similarly impede the natural infiltration of stormwater. STORMWATER CALULATIONS–IMPERVIOUS SURFACE NEW EXISTING Structures(all roof area) N/A sq/ft Structures(all roof area) N/A sq/ft Sidewalks N/A sq/ft Sidewalks N/A sq/ft Patios N/A ._sq/ft Patios N/A sq/ft Solid Decks N/A sq/ft Solid Decks N/A sq/ft (without infiltration below) (without infiltration below) Driveway,parking,roads,etc N/A sq/ft Driveway, parking, roads,etc 3655 sq/ft Other N/A sq/ft Other 288 sq/ft Total New ZERO sq/ft Total Existing 3943 sq/ft TOTAL NEW+TOTAL EXISTING* 3943 sq/ft *This amount will be used to check total lot coverage. The following questions will help determine whether the proposed project is considered development or redevelopment. DEVELOPMENT v. REDEVELOPMENT Divide the total existing impervious surface above by the size of the parcel and convert to a percentage: 17.76 Does the site have 35%or more of existing impervious surface? Circle: Yes No FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the attached Figure 1 should be used. At this juncture, the applicant should refer to the applicable Flow Chart to determine the Minimum Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements. For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of"medium" projects—those that must meet only Minimum Requirements #1 through #5—and for "large" projects—those that must meet all 10 Minimum Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan, principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual. APPLICANT SIGNATURE By signing the Stormwater Calculation Worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected property. 7 /1 1 t (l!$ R AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) stormwater calc worksheet—REV.2/20/2008 2 Map Output l Page 1 of 1 ArcIMS HTML Viewer Ma• i I 7!:•'_:+2•+.2+.:+_,2,': it1 1� _ 955f3GXbQE? w 1 \ wJ9__ I I • I 8 I'L, I ' 1 7P E Go-onna[r '- -� T Legend Selected Features . JC_Roads , Parcels F1 PP 9 �'tr,(i2X. -.=, s �,, 2013 Aerial Photos U 955y.Q. K 9S4ty�(ya�fi t ,i..)9,2*.,...)..,1,4 a!,.99201,t u_1cp-r 1a 11 '45Sf-100Q26 i 9. 5.:',1000241 f. GEES --; J _ _ I m.„. ,:r.ckd r.sal Corry'Cc-ra.Sam,o:s GtS FOR INFORMATIONAL PURPOSES ONLY- Jefferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its correctness or validity. Data contained in this map is limited by the method and accuracy of its collection. 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Fri Sep 12 10:22:38 2014 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientVersion=4.0&Form=True... 9/12/2014 Map Output • • Page 1 of 1 ArcIMS HTML Viewer Map 601273013 60'2/3023 I 95,0(10020--7-1 --; , 1 , 1 9,5000024 954900002 li ;1 958C41411017 955000019 moon., 96•490(X105 I ] 955000018 I il li 955000022 I 95493C4101 964900003 ; 964.4(xxx* I 9,6009023 I ,1 954900004 (1114 ' MP" -E Go-orina gt- Legend , _ ----1---F- ' JC Roads l----- Parcels-H (11 Parcel Tags-H t; 96000030 0 965000325, 94"°271 I %5cc".2**-:`=" I No Specoi Report 955c.I.X)32 Of:19(X*32 ....19..:00.1.0 ...,..yry.y.)2,H, 056000026 1 ge6c60029 . Spec ut Report I I r 601273022 604273022 . 1 I i 1 601273024 %Jos wormed by Jefferson Cozy Conte Somas GIS 0 msesmonsomE'/91 FOR INFORMATIONAL PURPOSES ONLY- Jefferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its correctness or validity. 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C N O N `Z 00 O • • Northwest Real Estate Group Yen flwireless Network Operations&Engineering Verizon Wireless 15900-SE Eastgate Way M/S 231 Bellevue,WA 98008 June 10,2011 To Whom It May Concern Re: Verizon Wireless Letter of Authorization for Applicant/Agent Dear Reviewer, I am writing to provide authorization for Rick Cardoza to file zoning and building permit applications on behalf of Verizon Wireless at permit jurisdictions in the States of Washington,Oregon and Idaho. If you have any questions or concerns about the subject proposals,please contact Rick Cardoza,VZW's authorized agent for assigned projects,at 253-218-9017.Thank you. Sincerely, it 144, ft 4 I Shirley Vangen Real Estate Specialist PNW Network Operations Parcel Details Page 1 of 2 0 41 , ,., , _ ' Weather Station ' Databaae Took r 4, Maps Webcara -one County Info Departments Searci Parcel Number: 955000031 SEARCH Parcel Number: 955000031 Printer Friendly Owner Mailing Address: DAVID E WARD PO BOX 123 QUILCENE WA98376-0123 Site Address: 124 E GO-ON NA DR QUILCENE 98376 Section: 27 School District: Quilcene (48) Qtr Section: SW1/4 Fire Dist: Quilcene (2) Township: 26N Tax Status: Taxable Range: 1W Tax Code: 0323 Planning area: South Toandos Peninsula,Coyle Area (9) Sub Division: 9550 - GO-ON NA BEACH TRACTS #2 Assessor's Land Use Code: 9100 - Vacant Land Property Description: GO-ON NA BEACH TR DIV 2 LOT 31 Tax, A/V, Sa es, Photos, and Permit Data BiCq Data Map Parcel Plats&Surveys Septic Monitoring Info / ' AfAtinfl CONtrIMPAIWATOX, HOME I COUNTY INFO I DEPARTMENTS I SEARCH Best sewed nth ivic-oso't Internet Exo.cy-e-6.0 or later 1 6 Windows - Mac http://www.co.j efferson.wa.us/assessors/parcel/parceldetail.asp 9/10/2014 Parcel Details Page 2 of 2 • • http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp 9/10/2014 r • • WA1 BRINNON-2 ORIGINAL FIRST AMENDMENT TO OPTION AND LEASE AGREEMENT BETWEEN ROBERT D. WILSON AND VEDA WILSON, HUSBAND AND WIFE, AND DAVID WARD AND SEATTLE SMSA LIMITED PARTNERSHIP This First Amendment to Option and Lease Agreement is made this /G. day of Sc,,ly , 1999 between Robert D. Wilson and Veda Wilson, husband and wife, and David Ward, as successor-in-interest to H. Jean Ward, each as to an undivided '% interest ("Lessor") and Seattle SMSA Limited Partnership, as successor-in-interest to San Juan Cellular Limited Partnership, c/o AirTouch Communications, Inc. d/b/a AirTouch Cellular ("Lessee"). A. Whereas, on the 16th day of December, 1993, Lessor and Lessee entered into an Option and Lease Agreement ("Agreement"), and a Memorandum thereof, said Memorandum having been filed on the 3rd day of January, 1994 under Jefferson County Auditor's File No. 374875; B. Whereas, by the terms of the Agreement, Lessee has the use of 3,000 square feet and an access easement thereto ("Site") as described in Exhibit A attached hereto. c. Whereas, U S WEST Wireless, L.L.C. ("USWW') desires to utilize a portion of the Site for a communications facility consisting of tower space on Lessee's tower and ground space for an equipment cabinet including rights-of-ways and easements for ingress, egress and utilities thereto. D. Whereas, the parties wish to modify the parties known as Lessee and Lessor. Now, therefore, for good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties hereto agree as follows: 1. Effective April 6, 1998, U S WEST NewVector Group, Inc. merged with AirTouch Communications, Inc. Accordingly, by operation of law, all right, title and interest of U S WEST NewVector Group, Inc. in the lease was transferred and conveyed unto AirTouch Communications, Inc. and Lessor hereby acknowledges such transfer. 2. Effective November 20, 1996, David E. Ward assumed all right and title to the • • Agreement from Helen J. Morris, formerly known as Helen J. Ward, as shown on that Quitclaim Deed, dated November 6, 1996, said Deed having been filed on the 22nd day of February, 1999 under Jefferson County's Auditor number 086361. 3. Lessor agrees to allow Lessee to sublet tower space and ground space to USWW for the purpose of placing USWW's communications equipment on Lessee's tower and ground space within the Site. Upon execution of a Tower Sublease Agreement ("Sublease Agreement") between Lessee and USWW, Lessor shall allow Lessee to sublet tower and ground space to USWW along with the non-exclusive right for ingress and egress, seven (7) days a week, twenty-four(24) hours a day, on foot or motor vehicle, including trucks, and for the installation and maintenance of utility wires, cables, conduits, and pipes over, under or along a twenty foot wide right-of-way and easement extending from the nearest public right-of-way, E. Go-Onna Drive, to the Site. The right- of-way and easement for ingress, egress, and utilities are described herein n Exhibit B. 4. USWW shall be responsible for rental and sublease payments as follows: a. In consideration of the Sublease Agreement and Lessor's consent thereof, USWW shall pay directly to Lessor an annual fee of Six Thousand Dollars ($6,000.00) in equal monthly installments to Robert Wilson and David Ward, each having separate checks in the amount of half of one month's rent. Each installment shall be paid in advance, without notice or demand, on or before the first day of the month. The first payment shall be due upon commencement of the Sublease Agreement and based on a pro rata share. The term of the Sublease Agreement shall run concurrent with the Agreement. b. For each renewal term of the Sublease Agreement, USWW shall pay Lessor as follows: Renewal Term Annual Amount 5. Payment of the sums described herein shall be the sole responsibility of USWW. In the event of default in rent payments to Lessor by USWW, such default shall in no way affect Lessee's use of the Site. 6. Section 20 of the Option and Lease Agreement shall be modified to read: "Lessee shall have the right, without prior consent of Lessor, to assign or transfer this Agreement or to sublet the tower, to (i) any parent, subsidiary, or affiliate entity, or (ii) any successor which acquires all or substantially all of the assets of Lessee, or (iii) any other entity to which Lessee transfers ownership of, and/or management responsibility for, a majority of its antenna support towers in the market in which the facility is located, which assignment or transfer shall fully release Lessee from any further obligations or liability under the terms of this Agreement commencing on the effective date of the assignment or • • transfer. Notwithstanding the above, Lessee shall not sublet the ground space within the Premises without the prior written consent of Lessor." 7. Except as expressly amended herein, all terms and provisions of the said Agreement shall remain unchanged and in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this instrument as set forth below: LESSOR: Robert D. and Veda Wilson TENANT: Seattle SMSA Limited and David E. Ward Partnership By: AirTouch Communications, Inc. Its: General Partner By: lX�" By: Name: Robert D. Wilson Name: I Ctaustim Date: "1-1 (.3 -C4 cl Its: Director,NW Netwnee n..e / By: //A A4.41AWA, e: V-1/g Name: Veda Wilson Date: By: ,tV a._..� r.�c—--C Name: David E. Ward/ Date: 7- / ‘ - 9 (// • • INDIVIDUAL ACKNOWLEDGMENT STATE OF (-e) S ) ) SS. COUNTY OF ,cue M-sO-v ) /i On this day person ly appeared before me 1�r�O�zi l2 iv;/.5c.0 V e dct (a: r/ $•r/ / pee v ;a4 ,5, Lt,,46c/ , to me known to be the individual(s) described in and who executed the within and foregoing instrument, and acknowledged that,l e,(she#‘l-tey signed the same as his/her/their free and voluntary act and deed, for the us@s'a ,p} hqherein mentioned. GI � ��official seal this /6 day of -"1-///y , . • 493S4 I : 9c-e.Z.-. #1 )0/....- or fi `N ''�A?S Print or Type Nam �1'C?�-v A,. -.1-6,�i,s7o i II 1 ��.'''■''_'',`b` Notary Public in and for the State of (J'4 I'I I, WA` residing at / /-�ea-c-d My appointment expires: ��-2S°"''-•C 0D PARTNERSHIP ACKNOWLEDGMENT STATE OF WASHINGTON ) ) SS. COUNTY OF KING ) On this 1-t/l day of PrU 3+ , 199 CI , before me, the undersigned, a Notary Public in and for thete of Washington, duly commissioned and sworn, personally appeared Gregg Clausius to me known to be Director, Northwest Operations and Engineering, of AirTouch Communications, Inc. the general partner of Seattle SMSA Limited Partnership, the partnership that executed the foregoing instrument and acknowledged the said instrument to be the free and voluntary act and deed of said partnership, for the uses and purposes therein mentioned, and on oath stated that/she is authorized to execute the said instrument. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my official seal the day and year first above written. \l �,,'� ' r, !i ?�• . .LA Aii!!.�A • ;',,;rAp A Rk ) Print or Type Name: rf r CI E?h t J.,:: ..--:::+ ^ : Notary Public in and for the State of WA, .n '. .A A ; Y c U e L1 G`'�: a residing at [ -OI(kct i U A- , �. `?3�C Ø .•� My appointment expires: U(gel!CO v A 'kr. , N • • OF rF t; :CADS awe/ i1`e,0 tie a4 DEC 14 PM 12`,3" 67 :9 JT G:t , ril WA 1 BRINNON-2 377673 �,�' u NOTICE OF EXERCISE OF OPTION ORIG!NAL On December 16, 1993 San Juan Cellular Limited Partnership as Optionee/Lessee, and Robert D. Wilson and Veda Wilson and David Ward and H. Jean Ward as Optionor/Lessor, entered into an Option and Lease Agreement of which a Memorandum dated January 3, 1994 was recorded August 29, 1994 under recording No. 374875 in the records of Jefferson County, State of Washington. The Option and Lease Agreement concerns the property described on Exhibits A and B which are attached hereto and incorporated herein by this reference. On October 15, 1994, the Option to Lease was exercised and the Optionee/Lessee, San Juan Cellular Limited Partnership became Lessee of the property under the terms and conditions specified in the Option and Lease Agreement. Optionee/Lessee: San Juan Cellular Limited Partnership By: U S WEST NewVector Group, Inc. General Partner By: 1 . Its: Home Office Real Estate Manager' lI_ Date: < DEC 4 "4 oL 519 • • • STATE OF WASHINGTON ss. COUNTY OF KING On this of I\)ay-i2" k1 , 199 , before me, the undersigned, a Notary Public in and for the State of Washington, duly commissioned and sworn, personally appeared Michael A. Cummings to me known to be the Home Office Real Estate Manager of U S WEST New-Vne�for o p, Irk., thQ�neral partner of ,�,i • �i4 `� the partnership that execut ► the foregoing instrument, and acknowledged the said instrument to be the free and voluntary act and deed of said partnership, for the uses and purposes therein mentioned, and on oath stated that he is authorized to execute the said instrument. WITNESS my hand and official seal hereto affixed the day and year first above RFC f., ri 1 � ., ��.� PPTA �• ■ . g10NO.A, to :4 �9�• : ARY PUBLIC in and for the •0 NOTARY N • • _ ? State of Washington • - ' Pueua � 2: residing at King County / • N1: �': p� �� 1b i � .o m; '•,9jk••9jt 28,;°••..�.�' My Commission expires "08.1111130°.WAS ,'s vuL 518 PA. 784 rli ,404 Ill i v\'D d r" v CA (N.1--d N N N O N U7 d U o .) N t- [ M ---Z L Z pI o C S N t3 Z co N V Q Y /� N o '•-• o U C -4 U 1l i 11 4 L 7 V L q 0 u0 w N X a •-• ,u 44 Y p WI . 2o1 ed rwwr i N o 441 U U 4 W .. 1. o co ✓ • • ✓ O U V I L. `pA . 1,4,::::.7 V 4. 0 13 •C Q MIMI V 01 e O `7 )- to V ) e O D 0 II- n 4:3 0( ,}D J V 4 V N 0 O Cr` -V — e U C C 4 0 -.-1 0 ...--. E.. L. N 0 - a a+ ‘r C .- a . a M a• r. . ., p d c - ct m ov Q o .. c e 0 O • 4 e M O_V.o O A C • C/) Z Z - / O . om UV i Z 1 n 0^ O pp ✓ p t� .� 44 ■ n m /f N_ I --. O - u U ��(4 O 4,+ 4) '^ c 0 O c U 4 J — V O d 7 .a C — 't� •" 5 7 e ✓ i' 1 v w U 4 -+ I n C f --- 43.0 00 ■ o > r` a O t` n ✓ C — Z7 C -.r- U •e C -4 () ( ) • 1 .t''4.: a i . . 4, p '+:►" t r� ,. '12'1s� AP r VOL 51.8 "Adr.785• O,`,_•....• •r+..,.. V -- -�-.err-r_rrL-47144* • • ORIGINAL WA 1 BRINNON 2 OPTION AND LEASE AGREEMENT This Option and Lease Agreement ("Agreement") is made as of the 16th day of December, 1993, between Robert D. Wilson and Veda Wilson, husband and wife: and David Ward and H.Jean Ward, husband and wife, each as to an undivided 1/2 interest ("LESSOR") and San Juan Cellular Limited Partnership("LESSEE"). RECITALS A. LESSOR is the owner of certain real property located in Jefferson County, Washington State, described in Exhibit A attached hereto and made a part hereof by this reference(the"Property"). B. LESSEE desires to obtain an option to lease a portion of the Property to be determined by LESSEE, including rights-of-ways and easements for ingress, egress, and utilities thereto, consisting of approximately 3000 square feet(The "Premises"). The Premises are also described within Exhibit A attached hereto and made a part hereof by this reference. The Premises may be more specifically described following a survey which may be obtained at a later time. OPTION AGREEMENT 1. Option Grant. In consideration of ent"), to be paid by LESSEE to LESSOR after execution of this Agreement by both parties, SSOR hereby grants to LESSEE the right and option (the "Option")to lease the Premises on the following terms and conditions. The date on which this Agreement has been executed by both LESSOR and LESSEE shall thereafter be considered the"Effective Date" of the Agreement. 2. Option Term. The Option may be exercised at any time within LESSEE's discretion, but no later than one year from the Effective Date ("Option Period"). LESSEE may extend the time during which the Option may be exercised for an additional Option Period of one year, upon providing written notice to LESSOR postmarked prior to the expiration of t e ption eno an the payment o d itiona ption Period. The time during which the Option may be exercised may be further a mutual agreement in writing. LESSOR agrees to notify LESSEE immediately if at any time during the term of this Agreement, LESSOR decides to subdivide, sell, or change the status of the Premises or the Property, or if LESSOR learns of any pending or threatened or contemplated actions, litigation, claims, condemnations, or other proceedings which would affect the Premises or any part of the Premises. 3. Exercise of Option. LESSEE may exercise the Option by giving notice to LESSOR of the exercise of the Option at any time during the Option Period. If LESSEE exercises the Option thirty(30) days or more before the end of the Option Period, or any extension thereof, the Option Payment or extension payment shall be prorated on a daily basis and a portion of the Option Payment, or extension payment, which is proportionate to the amount of time remaining in the Option Period, or OLA002 9/1/93 • extension thereof, shall be applied to the rental payments due under Section 10 of this Agreement. 4.Termination of Option. If LESSEE fails to exercise this Option or any extension thereof within the time specified in Section 2, all rights and privileges granted in this Agreement shall be deemed completely surrendered,this Option shall be terminated, and LESSOR shall retain all money paid for the Option, and no additional money shall be payable by either party to the other. 5. Legal Description. LESSOR grants LESSEE the right, but not the obligation, at any time during the term of this Agreement, to obtain a survey of the Premises at LESSEE's expense. The legal description that may be derived from the survey will become Exhibit B which will be attached hereto and made a part hereof, and shall control in the event of any inconsistency between it and Exhibit A. 6. Right of Entry. LESSOR shall permit LESSEE,during the Option Period or extension thereof, free ingress and egress to the Property to conduct surveys, structural strength analyses, subsurface boring tests, feasibility and final configuration assessment, environmental assessments, and other inspections of the Property as LESSEE may deem necessary at LESSEE's cost. At the expiration of the Option Period or any extension thereof, if LESSEE does not exercise its Option, LESSEE will restore the Premises to their original condition at the Effective Date, reasonable wear and tear excepted. 7. Recording of Memorandum. LESSOR shall execute and LESSEE shall be permitted to record at any time a Memorandum of this Agreement. LESSEE shall also be permitted to record a notice of exercise of the Option,which shall evidence the commencement of the lease concurrent with the exercising of the Option as provided for herein. If the Option is not exercised or if the lease portion of this Agreement is terminated prior to the expiration of its term, LESSEE shall record an appropriate instrument to clear the memorandum from the title to the Property. LEASE AGREEMENT 8. Lease Term. The term of this Lease shall begin on the Commencement Date and shall expire on the Expiration Date. The "Commencement Date" shall be the date within the Option Period set forth in LESSEE's notice of exercise of the Option. The Expiration Date shall be the date preceding the fifth anniversary of the Commencement Date, or as extended pursuant to section 9. Upon exercise of the Option, LESSOR shall deliver possession of the Premises to LESSEE,together with the non-exclusive right for ingress and egress,seven (7)days a week,twenty-four(24) hours a day, on foot or motor vehicle, including trucks, and for the installation and maintenance of utility wires, cables, conduits, and pipes over, under, or along a twenty-foot-wide right-of-way and easement extending from the nearest public right-of-way E. Go-Onna Drive to the Premises. LESSOR agrees to execute without delay any easement documents as may be required by any utility company in connection with LESSEE's use of the Premises. The Premises, right-of-way, and easement for ingress, egress, and utilities are described herein in Exhibit A. • erms. LESSEE shall have the right to extend the term of this Lease for up to d, at the end of the fourth five-year extensio and for annual periods thereafter. 2 OLA002 9/1/93 • • Notice of the exercise of the right to extend the term may be given by LESSEE to LESSOR in writing at least six(6) months before the end of each such period. Notwithstanding the foregoing,this Lease may be terminated during any of the one-year renewal periods by either party giving notice to the other at least six(6) months before the end of such period. 10. Rent. i or pla - • . ' . ea I)clays before any rental payment date. 11. Extension Rental Amount. The annual rental for shall continue to be paid in monthly installments and shall be incre. -r annual re - •rt ua - a for the annual rental shall b- monthly installments. 12.LESSEE's Use. LESSEE shall use the Premises for the purpose of constructing,maintaining, and operating a communications facility and uses incidental thereto(the"Facility")consisting of an equipment shelter together with an antenna structure and necessary connecting appurtenances sufficient to be a fully operable Facility in its intended licensed communications coverage areas. The contents of the equipment shelter may include,without limitation, radio transmission and computer equipment, and emergency battery and generat•r equipment. A security fence consisting of chain link or comparable construction may be • placed around any improvements constricted on the Pre ises by LESSEE.All improvements shall be at LESSEE's expense. LESSEE shall maintain the Premises in reasonable condition. 13.Governmental Approvals. It is understood and agreed that LESSEE'S ability to use the Premises is contingent upon its obtaining and maintaining all the certificates, permits,and other approvals that may be required by any federal, state,or local authorities. LESSOR shall cooperate with LESSEE in its efforts to obtain such approvals and shall take no action which would adversely affect the status of the Premises with respect to the proposed use thereof by LESSEE. In the event that any of such applications should be rejected or any certificate,permit,license,or approval issued to LESSEE is canceled,expires, lapses,or is otherwise withdrawn or terminated by any governmental authority so that LESSEE, in its sole discretion,will be unable to use the Premises for its intended purposes, LESSEE shall have the right to terminate this Lease. In addition, LESSEE will have the right to cancel this Lease at any time on not less than thirty(30)days prior notice to LESSOR ("Lessee's Notice"). If LESSEE exercises its right to terminate this Lease,LESSEE shall pay to LESSOR an amount equal to three (3) months rent applicable to the year in which LESSEE's Notice is given(the'Termination Payment"). Upon 3 OLA002 9/1/93 • • Notice of the exercise of the right to extend the term may be given by LESSEE to LESSOR in writing at least six (6) months before the end of each such period. Notwithstanding the foregoing,this Lease may be terminated during any of the one-year renewal periods by either party giving notice to the other at least six(6) months before the end of such period. 10. Rent. rm;orpla - . •- - ea • _ I)days before any rental payment date. 11. Extension Rental Amount. The annual rental for shall continue to be paid in monthly installments and shall be incre• -• annual re - •r t ua - - a for the annual rental shall b- monthly installments. 12.LESSEE's Use. LESSEE shall use the Premises for the purpose of constructing,maintaining, and operating a communications facility and uses incidental thereto(the"Facility")consisting of an equipment shelter togetherwith an antenna structure and necessary connecting appurtenances sufficient to be a fully operable Facility in its intended licensed communications coverage areas. The contents of the equipment shelter may include,without limitation,radio transmission and computer equipment, and emergency battery and generat•r equipment. A security fence consisting of chain link or comparable construction may be • placed around any improvements constructed on the Pre ises by LESSEE.All improvements shall be at LESSEE's expense. LESSEE shall maintain the Premises in reasonable condition. 13.Governmental Approvals. It is understood and agreed that LESSEE's ability to use the Premises is contingent upon its obtaining and maintaining all the certificates, permits,and other approvals that may be required by any federal, state,or in its efforts to obtain such approvals and shall take no action which local authorities. LESSOR shall cooperate with LESSEE n PPro would adversely affect the status of the Premises with respect to the proposed use thereof by LESSEE. In the event that any of such applications should be rejected or any certificate,permit,license,or approval issued to LESSEE is canceled,expires, lapses,or is otherwise withdrawn or terminated by any governmental authority so that LESSEE,in its sole discretion,will be unable to use the Premises for its intended purposes,LESSEE shall have the right to terminate this Lease. In addition,LESSEE will have the right to cancel this Lease at any time on not less than thirty(30)days prior notice to LESSOR ('Lessee's Notice"). If LESSEE exercises its right to terminate this Lease,LESSEE shall pay to LESSOR an amount equal to three(3) months rent applicable to the year in which LESSEE's Notice is given (the"Termination Payment"). Upon 3 OLAO02 9/1/93 • • LESSEE's compliance with the terms of this section,LESSEE's payment of all amounts owed to LESSOR under the Lease,and LESSEE's compliance with the provisions of the Lease regarding surrender of the Premises,the Lease will terminate as of the date set forth in LESSEE's Notice,and neither LESSOR nor LESSEE will have any further rights or obligations under the Lease except with respect to those matters in the Lease which expressly survive a termination of the Lease. Such termination payment shall be due at the time of termination of the Lease. All rentals paid for the lease of the Premises to said termination date shall be retained by LESSOR. Upon such termination,this Lease shall become null and void and all the parties shall have no further obligations, including the payment of money to each other. 14.Indemnification. LESSEE shall indemnify and hold LESSOR harmless against any claim of liability or loss from personal injury or property damage caused by the negligence or willful misconduct of the LESSEE, its servants or agents except to the extent that such claims or damages may be due to or caused by the acts or omissions of the LESSOR, its servants, agents,or any other party for whom LESSOR may be responsible. 15.Insurance. LESSEE agrees to procure public liability insurance for claims for personal injury or death and property damage with limits of not less than$1,000,000 combined single occurrence limit. LESSEE may satisfy this obligation through a program of self-insurance. 16. Utilities and Taxes. LESSEE will be responsible for all utilities required by its use of the Premises. LESSEE may at any time arrange to have its utilities separately metered or will pay its proportionate share of utilities furnished by LESSOR. LESSEE will pay any increase in real estate taxes caused by the improvements constructed thereon by LESSEE. In the event that the real estate tax assessment on LESSOR's property reflects LESSEE's improvements, LESSOR agrees to provide to LESSEE in a timely manner a copy of the assessment. LESSEE may contest,at its expense, any assessment imposed on the Premises or LESSEE's activities. 17.Termination. LESSEE shall, no later than sixty(60)days after the termination of this Agreement, remove its personal property and fixtures and restore the Premises to its original condition, reasonable wear and tear excepted. If time for removal causes LESSEE to remain on the Premises after termination of this Lease,LESSEE shall pay rent at the then existing monthly rate or the existing monthly pro-rata basis if based on a longer payment term,until such time as the removal of the personal property and fixtures is completed. At LESSOR's option,which shall be exercised by written notice to the LESSEE no later than sixty(60)days prior to the termination of this Lease,LESSEE will leave the foundation and security fence which shall become the property of LESSOR. 18. Title and Quiet Enjoyment. LESSOR represents and warrants to LESSEE that(a) LESSOR has full right, power, and authority to execute this Agreement;(b)LESSOR has good and marketable title to the Premises free and clear of any liens or mortgages except as set forth in Exhibit"C"attached hereto and incorporated herein by this reference; (c)the Premises constitute a legal lot that may be leased without the need for any subdivision or platting approval;and(d)there is direct legal ingress and egress to the Premises for vehicles and pedestrians from a public right of way. LESSOR further covenants that LESSEE shall have quiet enjoyment of the Premises during the term of this Agreement and any renewal thereof. For any encumbrance reflected in Exhibit"C", LESSOR will promptly obtain from such encumbering entity a non-disturbance agreement 4 OLAOO2 911/93 • • stating that,so long as LESSEE is not in default hereunder this Agreement will continue in full force and effect. 19. Environmental Matters: (a)LESSEE will be solely responsible for and will defend,indemnify and hold LESSOR,its agents, and employees harmless from and against any and all direct claims,costs,and liabilities,including attorney's fees and costs,arising out of or in connection with the cleanup or restoration of the Property associated with the LESSEE's use of Hazardous Materials. (b) LESSOR will be solely responsible for and will defend, indemnify,and hold LESSEE,its agents,and employees harmless from and against any and all direct claims,costs,and liabilities, including attorney's fees and costs,arising out of or in connection with the removal,cleanup,or restoration of the Property with respect to Hazardous Materials from any and all sources other than those Hazardous Materials introduced to the Property by LESSEE. (c) "Hazardous Materials"means asbestos or any hazardous substance,waste or materials as defined in any federal,state,or local environmental or safety law or regulation including, but not limited to,CERCLA. The obligations of this section shall survive the expiration or other termination of this Agreement. 20.Successors and Assigns. This Agreement shall run with the Property and shall be binding on and inure to the benefit of the parties,their respective successors, personal representatives and assigns. 21.Complete Agreement. It is hereby mutually agreed and understood that this Agreement contains all agreements, promises,and understandings between LESSOR and LESSEE and that no other agreements, promises, or understandings shall or will be binding upon either LESSOR or LESSEE in any dispute,controversy,or proceeding at law,and any addition, variation,or modification to this Agreement shall be void and ineffective unless in writing and signed by the parties hereto. 22.Applicable Law. This Agreement and the performance thereof shall be governed, interpreted,construed, and - regulated by the laws of the state in which the Premises is located. 23.Attorney's Fees. In any action is brought to enforce the terms of this Agreement,the prevailing party shall be entitled to recover from the party not prevailing its reasonable attorney's fees and other reasonable costs incurred in enforcing this Agreement, including costs incurred on appeal. 24. Waiver of Jury. LESSOR and LESSEE each hereby waive trial by jury in any action, proceeding or counterclaim brought by either against the other on any matter arising out of or in any way related to this Agreement,the relationship of LESSOR and LESSEE,LESSEE's use or occupancy of the Premises or any claim of injury or damage or any statutory remedy. 25.Notices. All notices, request,demands,and other communications under this Agreement shall be in writing,and shall be deemed to have been duly given on the date of service if served personally on the party to whom notice is to be given, or on the third day after postmarked if mailed to the party to whom notice is to be given,by first-class mail, registered or certified, return receipt requested, postage prepaid,and properly addressed as follows: s OLA002 9/1/93 • To LESSEE: San Juan Cellular Limited Partnership do U S WEST NewVector Group,Inc. P.O.Box 91211 Bellevue,WA 98009-9211 OR 3350-161st Avenue Southeast Bellevue,WA 98008-1329 Attn: Property,Construction and Development Services Telephone: (206)747-4900 To LESSOR: Mr.David Ward and Mr.Robert Wilson P.O. Box 238 Quilcene,WA 98376 Attn: Dave Ward Telephone:765-3699 Any party may change its address for purposes of this paragraph by giving the other party written notice of the new address in the manner set forth above. IN WITNESS WHEREOF,the parties hereto have set their hand and affixed their respective seals the day and year first above written. LESSOR: Robert D.Wilson and Veda Wilson David Ward and H.Jean Ward 'o6-rt 9.Wilson Veda � n aid Ward H.J Ward SS#or Taxpayer I D# Date: 1-`r -`1 - LESSEE: San Juan Cellular Limited ParTners '" - IS-.`\° By: U S WEST NewVector Group, Inc. General Partner By: l`l� _ Its: Director Field Operations Date: '-72-rt/ 6 OLA002 9/1/93 • • c^ � ti 1 rtAA ( ) ,. rft CO o N MnP Z n � o ^ arO 1 < , • g ' 7 U • r C) ^ — A A a o 6 LA•••• oc , ° © O _ 6 re A r O - • '.A 9-< r 'D•0 n r*Al.o c71 N 0 a - n o. O a 2 Z c•' •^A fr. • .. O aA 0 A — a < • 'U , Z w , O l+ o d h.O 1°3> Aa . • 'O '+ . vO r 4 r.,.r) W A } ft, ■ 1• f ft P. A) M .1 Hi ■ T_ . O r A h 7 7 A a O. .noA)— N th •• -t n n n O o a fn ; a O o b Al 37 C `< f.... O ' , b O. Q 0 •h r n7 CYte Rd. n .t.0 . A A a A O r+ n O 7 O --� .t on r O.e)r• —.ao ` U 0 r Z. cra 4. _ . n o =A n I N 0 O) w a n 0 • Yo a- zi c > A A d .-,1 N — O n� p -4 0 < t0 Al o n .. frl O. O 2. w • - N N Cr) 0 N N z � X S N Q N N A Z , Z 37 (--* N__. - - - - - - `,+ o 4) W N Z. �j} N\v-U N v X F n o� °; - W $U U • • INDIVIDUAL ACKNOWLEDGMENT STATE OF — I )ss. COUNTY On this day personally appeared before me • ;e0;;LA , to me known to be the individual described in and who executed the within and foregoing instrument, and acknowledged that Q _signed the same as__p,�_Y free and voluntary act and deed, for the uses and purposes ther • entioned. GIVEN under my hand and official seal this '`l day of 19 0i^k . Notary Public in and for the State • residing at ` e„ „ My appointme t expires:._ \\_\s-qb INDIVIDUAL ACKNOWLEDGMENT STATE OF lss. COUNTY OF f On this day personally appeared before me v .� ��` , to me known to be the individual described in and who executed the within and foregoing instrument, and acknowledged that signed the same as \313,A,sF, free and voluntary act and deed, for the uses and purposes there entioned. GIVEN under m hand and offi ial -. .' •, • '1_ Notary Public in and or the State of\� • +� residing at � a � My appointme t expires:_ \\_A5_qk, t( . L At-tos) fS • S INDIVIDUAL ACKNOWLEDGMENT STATE OF `���� I \ Iss. COUNTY O� \.:`��� On this day personally appeared before me �� � � , to me known to be the individual described in and who executed the within and foregoing instrument, and acknowledged that signed the same as NQ„),eN free and voluntary act and deed, for the uses and purposes the mentioned. GIVEN under my hand and official seal this 1.--\ day of■ f g cv.v. r � , Notary Public in and for the State of \� residing at My appointment expires:__LS INDIVIDUAL ACKNOWLEDGMENT STATE OF � cic —;_--) ►ss. COUNTY OFL_ a,� On this day personally appeared before me known to be the individual described in and who executed the within an• foregoing instrument, and , to me acknowledged that signed the same as free and voluntary act and deed, for the uses and purposes ther • entioned. GIVEN under my hand and official seal this .. . • Notary Public in and for the 7a7-07 ".. residing at My appointment expires: \\_∎g Te1,+Yi c (Q L 4 ' I 4 n f� • • CORPORATE ACKNOWLEDGMENT STATE OF )ss. COUNTY OF • On this day of , 19 , before me • sonally appeared to me known to be the of , the co •oration tha •xecuted the within and foregoing instrument, and acknowledged said instrument to be the fre• and • untary act and deed of said corporation, for the uses and purposes therein mentioned, and on oat .tated that_ was authorized to execute said instrument and that the seal affixed, if any, is e cor..rate seal of said corporation. IN WITNESS WHEREOF, I ha ereunto set my h..d and affixed my official seal the day and year first above written. Notary Public in and for the State of residing at _ My appointment expires: (11-) PARTNERSHIP ACKNOWLEDGMENT STATE OF ) Iss. COUNTY OF Q °1(-1 n t d, day of m,O-A-C.ki , 19(4, before me perbi it 0 a to me known to bete �� r.norutperatIons of 0 S UJT �'�. r N G. • , the general partner of • . , • ,01111111 , • the •artnershi• h. _ .• . • .•. . the free and voluntpry act and deed of said partnership, for the uses and purposes therein mentioned, and on oath stated that` Q,, was authorized to execute said instrument and that the seal affixed, if any, is the seal of said partnership. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my official seal the day and a v ♦ Y d year bo �♦N11�M.�4 • • ♦♦. Pip REQO .,� it •. - �y Not r is in and for the State of WA- :c4 C �,� residing at C <. pUeU � � My appointment ex res: 9 • IL 2g, •• O Bo•° -.stoma• Parcel Details Page 1 of 2 'leffeioon County Pg'7 dome County Info Departments Searc-hl Parcel Number: ;955000031 r SEARCH Parcel Number: 955000031 Printer Friendly Owner Mailing Address: DAVID E WARD P(] BOX 123 QUILCENE WA98376-0123 Site Address: 124EGO-ONN/\ DR QUILCENE 98376 Section: 27 School District: Quilcene (48) Qtr Section: SW1/4 Fire Dist: Quilcene (2) Township: 26N Tax Status: Taxable Range: 1W Tax Code: 0323 Planning area: South Toandos Peninsula,Coyle Area (9) Sub Division: 9550 GO-ONNA BEACH TRACTS #2 Assessor's Land Use Code: 9100 - Vacant Land Property Description: GO-ONNA BEACH TR DIV 2 LOT 31 rax� x/v' so/es, Photos, anu Permit Data emo Data Map Parcel Plats &Surve s _Septic Monitoring Info_ _�-���_� (Minty WArititafOgi HOME iCOUNTY I DEPARTMENTS SEARCH Best-vwwed with Microsoft Intemc expm-e, or��r vvinuomn Mac http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp 9/10/2014 � �� Point& Pay - Create Order Page 1 of 1 • Thank you for your payment! This service has been provided by Jefferson County Dept of Community Development, WA and Point & Pay. We value your business. Please keep this receipt for future reference. You have made a payment to Jefferson County Dept of Community Development, WA . Jefferson County Department of Community Development thanks you for your payment. For questions about your account, please call 360-379-4452 Name: Richard Cardoza Address: 14201 NW 200st. Ste100, woodenville WA, US, 98072 Contact: 2532189017 Comments: Payment ID: 15033532 Date: 09/08/14 03:30 PM Subtotal: $673.90 Fee: $17.50 Total: $691.40 Method: Credit or Debit Card(***********5011) Item Purchased Transaction Description Account Amount Commercial Applications Jefferson Co C D GOV 95500031 S673.90 Signature: Date: / / By signing this receipt you agree to the terms and conditions of this service. You will see one line item on your credit or debit card statement indicating the amount you paid and will be identified as Jefferson Co C D GOV. If you have any questions about the charges please call 1-888-891-6064. Print Receipt Close Window https://agent.pointandpay.net/pointandpay counter/viewReceipt.do?method=viewPaymentR... 9/8/2014 (/) -I0U'O(n G y _13C'A m moC m 1-0 m D D-I -4 u n �ccnzmv) No <mmD O Ol�v � 2-i -<—m o Z,C n gD mmZ mn= cn r- mm0< ▪ W Z X(/i- 2 0 — (700m 2n D° M Cl)> I 0 0 D-I 3 CO 0 — ._ — — (E) PROPERTY LINE - 301.72' Og m z m I� at m C)0 1 0 U q U ' —4 .... IL c:3 Q 289'±TOWER SETBACK zl ,....c .., _ ._ . 0 w w u, .. ... (E) PROPERTY LINE - 301.73' .. ... __ _ (n mµ ns DO (t X X7 ,F73 0K U mm cc0M Zx --I o Z.° (DTI 47 �mm °� 0 -.1,0 0< m s±-< 3m D mX oN (07 T10O ZZ N Z Z ° 0 7 cn m r Q r C o Co ( m D r z m m z z > �� rrl T rn i G 70 1 cz, 7 Z co I (--) GG/��f OG � OIP TRUE NORTH rrt µ " < 2 ° ° aim 0 0 _ ' m T' m ' rn mo D M� m ja n Z m m m *6 i- :i- m °: KN = 0 8 g _ g �D Z rn m x-. 2 8 2 o CO Z r Dm 0 ��„ o 9 m m a z �O (n a x� m a 1/el'/ 411 wireless A �O �— Z L N Am G n m co ° C Jefferson County Building Division Permit Number: BLD14-00329 Applicant: VERIZON WIRELESS BUILDING PERMIT INSPECTION APPROVALS Applicable Code: 2012 International Building Codes To schedule inspections, call (360)379-4455 no later than 3:00PM the day before the inspection is needed. Requests received after 3:00 PM will not be scheduled for the next days inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes Miscellaneous 2/WO third party review accepted in leu of inspection lanning Approval jie/1 4 No on site requirements per zoning. tr A final inspection will not be scheduled until the following are completed and signed off by the applicable Department: • Building Permit Conditions are met • Septic Permit Final/Complete for any building containing plumbing • Land Use Conditions met and signed off • Public Works Permit Final(where applicable) FINAL INSPECTION 171 i. 1< ildv FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • CONDITIONS for Building Permit# :BLD14-00329 1.) The proposal meets JCC 18.42.020(2)(d)which exempts the following from the provisions of Chapter 18.42 JCC: "Emergency or routine repairs, reconstruction, or routine maintenance of previously approved facilities, or replacement of transmitters, antennas, or other components of previously approved facilities which do not create a change in visual impact." 2.) The site plan as submitted with the building permit application on September 10, 2014 for the replacement of 5 Panel Antennas, addition of 3 RRUs, 2 OVP distribution box, 1 Hybrid Cable, and 3 TMAs has been reviewed for consistency under the UDC, and has been approved by Jefferson County Department of Community Development. Any modifications, changes, and/or additions to the stamped, approved site plan dated September 16, 2014 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 3.) This approval is for a replacement and colocation consisting of 5 Panel Antennas, adding 3 RRUs, 2 OVP Distribution Box, 1 Hybrid Cable, and 3 TMAs only. Any future permits on this site are subject to review for consistency with applicable codes and ordinances and does not preclude review and conditions which may be placed on future permits. 4.) TSW \\tidemark\data\forms\F_BLD_Permit_BIdg.rpt 12/30/2014 • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD14-00329 Received Date: 9/10/2014 SITE ADDRESS: 124 E GO-ONNA DR Issue Date 12/30/2014 QUILCENE, 98376 Expiration Date 12/30/2015 OWNER: VERIZON WIRELESS PHONE: 253-218-9017 RICK CARDOZA 14201 NE 200TH ST. #100 WOODINVILLE WA 98072 9550 SUBDIVISION: Block: Lot: 31 PARCEL NUMBER: 955000031 Section: 27 Township: 26 N Range: 1Vr CONTRACTOR: PRESCO TELECOMMUNTIONS INC PHONE: 206-459-6811 PAUL 32420 148TH AVE SE AUBURN WA 98092 Contractor's License PRESCTI073BN Expires 8/29/2015 PROJECT DESCRIPTION: Cell Tower Remodel- Replace 5 panel antennas, Add 3 RRU's, 2 OVP Distribution Box, 1 Hybrid cable, 3 TMA TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP ADD MAIN: INDUSTRIAL: VALUATION 18,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: Type Amount Paid By: Date: Receipt: BATHROOMS: Permit $256.00 SRE 09/08/14 151515 Exist: Plan Check $166.40 SRE 09/08/14 151515 Prop: State Building Code $4.50 SRE 09/08/14 151515 Total: Total: $426.90 NUMBER OF EMPLOYEES: Directions to Site: HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. Request must be received by 3pm the day before the inspection is needed. Office Hours 9:00 am -4:30 pm MONDAY- THURSDAY HOT LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS APPLY- SEE ATTATCHED