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4677 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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: a'a , Everett, WA 98203 PROPERTY TAX#:2805060040 00 <br /> LEGAL for new construction: Short Plat/subdivision Section 06 Township 28 Range 05 Lot No.3 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: City of Everett (Everett Safe Streets) TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY Everett STATE WA ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: A&R SOLAR <br /> CONTRACTOR ADDRESS: STREET 3211 Martin Luther King Jr Way S, Suite B <br /> CITY Seattle STATE WA ZIP 98144 <br /> CONTRACTOR PHONE: 206-707-9937 CONTRACTOR EMAIL:permits@a-rsolar.corn <br /> CONTRACTOR LICENSE#(REQUIRED):RSOLAS*903JM CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 053961 <br /> PRIMARY CONTACT: 0 OWNER B CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 360-621-8238 <br /> Wendy Wenrick CONTACT EMAIL: permits@a-rsolar.com <br /> BUILDING PERMIT APPLICATIONi� <br /> Existing Use of Building:Commercial Contract Price of Work: $ � . - . <br /> Proposed Use of Building:No change to building use Heat Source: DGas @Electric DOther <br /> Building Type: ❑SFR-Detached 0 SFR-Attached 0 Duplex 0 Multi-Family-#of Units: El Commercial 0 Industrial <br /> Type of Project: ❑New @Addition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Installing 222.84 kW photovoltaic system on roof <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 /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> 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 /> SPRINKLER /SUPPRESSION SYSTEM <br /> Chemical or Water 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.I am the owner,or I am 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 /> City of Everett Official Use Only <br /> PERMI <br /> () 1E0( ‘OS --(504 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> i �) <br /> /L <br />