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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> "1111/'� � CITY OF EVERETT PERMIT SERVICES <br /> !�' 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everetlwa.gov I www.everettwa.gov/permits <br /> ILE(Blue or Black Ink Only Please) : PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 4918 23rd Ave W,Everett,WA 98203 PROPERTY TAX#: 00644500000600 <br /> GAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Paul&Alison Vijgen TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 4918 23rd Ave W <br /> cm' Everett STATE WA zf° 98203 <br /> OWNER PHONE: 206-941-4867 OWNER EMAIL: vijgens@frontier.com <br /> CONTRACTOR NAME: Forecast Solar LLC <br /> CONTRACTOR ADDRESS: STREET 12820 Avondale Way <br /> cm, Everett STATE WA zp 98204 <br /> CONTRACTOR PHONE:425-487-6000 CONTRACTOR EMAIL: office@forecastsolar.com <br /> CONTRACTOR LICENSE#(REQUIRED): FORECRL955MK CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 044167 <br /> PRIMARY CONTACT: ❑OWNER 6 'CONTRACTOR O OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-487-6000 <br /> Will Habenicht CONTACT EMAIL: office@forecastsolar.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: SFR Contract Price of Work:$ Z,C 6 7 C19 <br /> Proposed Use of Building: SFR Heat Source: Deas ❑Electric °Other <br /> Building Type: OaFR-Detached °SFR °Duplex °Mufti-Family-f of Units: °Commercial °Industrial <br /> Type of Project: ONew °Addition aRemodel °Repair CIT.!. °Sign OSprinkler °Demolition °Change of Use <br /> DESCRIPTION OF WORK: <br /> Install 11.8 kW grid-tied,roof-mounted Solar PV system.40-Itek T-295-SE solar modules.40-SolarEdge <br /> SE-P320-60c optimizers, 1 -SolarEdge SE-10000H-US line inverter, Sunmodo EZ mount racking system. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project _New_ Addn Alteration Repair Type of Project _New Addn Alteration _Repair <br /> List ofRxtrwes t List of Fixtures 17x#[ewias List of Fbdnres t List of Fixtures <br /> FixturesNC—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 /> SPRINKLER t SUPPRESSION SYSTEM <br /> 'Chemical or Water 1 JNo.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this appLcatIon and co fhm the information contained herein Is due and coned Work done pursuant to thisparmli must comply weth <br /> currant federal,state,and local law.The granting of pe mitonly authorizes approved work and no deviations the+afrom.Deviations must list be authorized in wring from the <br /> Building Official before being authodzed under any circumstance.lam the owner,orf am authorized by the minorofthit property to perform the work for which appicetion is made, <br /> and I comply with the State Contractors Law 1&27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT* <br /> Owner! :/''''f..°?.- ---'--.-signahrre Date (Revised 9!23/2016) <br /> (-7,-,,,z) <br />