1425 BROADWAY GILMORE REAL ESTATE OFFICE 2021-02-22

PERMIT APPLICATIO. G ,BUILDIN ECHANICAL / PLUMBING / SIGN iSPRINKLER / DEMOLITION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS:1425 Broadway Everett WA 98201 PROPERTY TAX#:00475428701300 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Greg Campbell TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET 1425 Broadway CITY Everett STATE Wa ZIP 98201 OWNER PHONE: (425)405-4644 OWNER EMAIL:gcampbell7@me.com CONTRACTOR NAME:Blossom Solar LLC CONTRACTOR ADDRESS: STREET 1706 Lombard Ave CITY Everett STATE Wa Zip 98201 CONTRACTOR PHONE:425-610-7067 CONTRACTOR EMAIL:office@blossomsolar.com CONTRACTOR LICENSE#(REQUIRED):BLOSSSL823M7 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 57621 PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-610-7067 Matthew Peters CONTACT EMAIL:office@blossomsolar.com BUILDING INFORMATION Existing Use of Building:Single Family Residence Contract Price of Work: $27,200 Proposed Use of Building:Solar Heat Source: ❑Gas DElectric ❑Other BUILDING USE: OSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ERemodel ❑Repair ETA. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Installing 8.88 kW solar array, roof mounted and grid tied ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) Forced Air Systems Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER/ SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System No.of Heads 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 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 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, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERI�IT�p Matthew Peters Dale 2 2011signe 6110654-WOO' WO'by Malthew `t1!✓� 1� Owner/Authorized Agent Signatureae Zozo.,,.�„0�5<oe•Do Date (Revised 10/10/2018)