3429 KROMER AVE 2021-09-24 - Laserfiche WebLink

WCTRICAL PERMIT APPLTION EVERETT CITY OF EVERETT PERMIT SERVICE 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 PROJgc`"SITE,INFORMA 1ON'' 5 PROJECT ADDRESS: 3429 Kromer Ave Everett WA 98201 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ✓❑ REMODEL BUILDING USE: ❑✓ SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL E .t .,"E ;"EC�E'RIC�►1�Ah, PLICAT_� 1�I1 �QN.� DESCRIPTION Of WORK �.. �,... CONTRACT PRICE OF WORK:$ 34,000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Installing 12.95 kW grid tied solar PV system, swapping out Main Service Panel, no increase in amperes THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: ❑ Service ❑ Feeder ❑✓ Circuits-#: 1 ❑Complete Re-wire LOW VOLTAGE WORK? ✓❑ NO ❑YES-#of Devices: SELECT SCOPE (REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑ Secure Access ❑ Security System ❑ Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional Fire Alarm Permit is required for review of device location and installation approval. ❑ Other(List All): C /� `/►t� r IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑ NO ❑YES--See Below&Pg.2 I I By checking this box, I am stating that I have read and understand all of WAC 296-46B-900,selected the specific reason on page 2 of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ENO EYES-See Below&Pg.3 Li Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent,sale, or lease without the proper electrical licensing and certification,or exemption. By checking this box, I am stating that I have completed and See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT 1NFORMATIOI . ; OWNER NAME: Emily Shiflett TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 3429 Kromer Ave CITY Everett STATE Wa ZIP 98201 OWNER PHONE:(703)581-8990 OWNER EMAIL:emily.shiflett@gmail.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 LIC.#(REQUIRED):BLOSSSL823M7 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 57621 PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-610-7067 Matt Peters CONTACT EMAIL:office@blossomsolar.com AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. That 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 296.200 WAC. City of Everett Official Use Only PERMIT#: 7//az a(41- 10/21/2020 E 7Q)i c Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page -Application