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0 PERMIT APPLICATION 0 <br />BUILDING / MECHANICAL / PLUMBING I SIGN / SPRINKLER I DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />4err 3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-B610 I FAX 425-257-8857 l (E) everetteps@everettwa,gov I www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 2632 58th St SW <br />PROPERTY TAX #: 00813500002100 <br />LEGAL for new construction: Short PlaUsubdivislon Lot No, (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: Kathryn Logue TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET2632 58th St SW <br />Everell <br />CfTY STATE WA Zip 98203 <br />OWNER PHONE: NA <br />OWNER EMAIL: kitlogue@comcast.net <br />CONTRACTOR NAME:A and R Solar <br />CONTRACTOR ADDRESS: STREET3211 MLK JR WAY S, SUITE B <br />Cm, Seattle STATE NIA ZIP 98133 <br />CONTRACTOR PHONE: 206-707-9937 <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): RSOLAS`903JM, RSOLAS"825P9 <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 053961 <br />PRIMARY CONTACT: ❑ OWNER R CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />Wendy We n ri ck <br />CONTACT PHONE:206-707-9937 <br />CONTACT EMAIL: permits@a-rsolar <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: <br />Contract Price of Work: $ <br />Proposed Use of Building: <br />I Heat Source: ❑Gas ❑Electric ElOther <br />Building Type: OSFR-Detached ❑SFR-Attached ❑Duplex © Multi- Family-# of Units: OCommerclal Oindustrial <br />Type of Project: ❑New DAddition ❑Remodel ❑Re air ©T.I. ❑Sign ❑S rinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />Installing a 5.5KW Photovoltaic system on the roof. This meets the <br />OTC checklist. <br />ASSOCIATED BUILDING PERMIT # if applicable): <br />MECHANICAL <br />PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION' <br />Type of Project: <br />New Addn Alteration Repair <br />Type of Project: New _Addn Alteration Repair <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />A/C — Air Handilng Units <br />Heat Pump <br />Toilet <br />Backflow Preventer (inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory Wash Basin <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />Kitchen Sink & Disposal <br />Grease Trap <br />Gas Ran e <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />Other: <br />Ciothes Washer <br />Medlcal Gas <br />Range Hood <br />Water Heater <br />Other: <br />Exhaust Fan <br />Sink Service/Bar/Mop/etc. <br />Other: <br />SPRINKLER <br />/ SUPPRESSION <br />SYSTEM <br />Chemical or Water <br />I <br />JNo. 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 most 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 />8128/2020 <br />Agent Signature Date <br />City of Everett Official Use Only <br />PE I # `( <br />(Revised 912312016) <br />