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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/ DEMOLITION <br /> ` CITY OF EVERETT PERMIT SERVICES <br /> __ 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov www.everettwa.gov/perrnits <br /> (Blown ic1 ltfk Only Plea } . 'PRO E 1 .I +A I IA'!IO$ <br /> PROJECT SITE ADDRESS:4801 Harbor Lane,Everett,WA 98201 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT:tI± ORIIATION- <br /> OWNER NAME: Mary Morgan TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET PO Box 1002 <br /> cny Everett STATE WA zip 98206 <br /> OWNER PHONE: 425-355-9131 OWNER EMAIL: dancefool@netzero.net <br /> CONTRACTOR NAME: Blossom Solar LLC <br /> CONTRACTOR ADDRESS: STREET 1706 Lombard Ave <br /> CITY Everett STATE WA zip 98201 <br /> CONTRACTOR PHONE: 425-610-7067 CONTRACTOR EMAIL: info@blossomsolar.com <br /> CONTRACTOR LICENSE#(REQUIRED): BLOSSSL823M7 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 57621 <br /> PRIMARY CONTACT: 0 OWNER II CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: Cole Anderson CONTACT PHONE: 425-610-7067 <br /> CONTACT EMAIL: info@blossomsolar.com <br /> _BUILDING PEi T APPLICAZ ION T, <br /> Existing Use of Building: Contract Price of Work:$ Z ),2-0t <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric CI Other <br /> Building Type: CI SFR-Detached ❑SFR-Attached ['Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ElNew ['Addition ['Remodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ['Demolition ['Change of Use <br /> DESCRIPTION OF WORK: <br /> 9.15 kW grid tied solar system,roof mounted <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHALNICAL,PERMIT APPLICATION PLUMBING-PERMIT APPLICATION <br /> Type of Project: New _ Addn Alteration _Repair Type of Project: _New _Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> `SPRI1HKLER SUPPRESSION SYSTEM` , '' <br /> (Chemical or Water I (No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.lam the owner,or tam authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC <br /> pCit�y of Everett Official Use Only <br /> 1a/3b/I4l P ( l t 0 " <br /> OwnerlAuthorized(Oi ent na re Date (Revised 9/23/2016) <br /> 9 � <br />