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ELECTRICAL PERMIT APPLICATION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 710 35th St SE BUILDING AREA: sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION El ADDITION ❑✓ TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: n SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK:$ 14860 ,ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> install rooftop solar electric and 10kw inverter with Rapid Shutdown included. no batteries. <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? El NO ❑✓ YES-Select Scope: ❑ Service ❑ Feeder ❑✓ Circuits-#:1 ❑ Complete Re-wire <br /> LOW VOLTAGE WORK? ✓❑ NO ❑YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑Audio ❑ Secure Access ❑Security System <br /> Cl Fire Alarm- Installations under this permit only include electrical wiring rough-in of the system.An additional <br /> Fire Alarm Permit is required for review of device location and installation approval. <br /> ❑ Other(List All): <br /> CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑✓ NO ❑YES--See Below&Pg.2 <br /> 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 <br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not <br /> See Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: NO ❑✓YES-See Below&Pg.3 <br /> Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease <br /> without the proper electrical licensing and certification,or exemption.By checking this box, I am stating that I have completed and <br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> CONTACT INFORMATION <br /> OWNER NAME: Wally Stover TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 710 35th St SE <br /> CITY Everett STATE ZIP 98201 <br /> OWNER PHONE:(425) 870-5315 OWNER EMAIL:wostover@yahoo.com <br /> CONTRACTOR NAME: Sunergy Systems Inc <br /> CONTRACTOR ADDRESS: STREET4546 Leary Way NW CITY Seattle STATE WA ZIP 98107 <br /> CONTRACTOR PHONE:206-571-4726 CONTRACTOR EMAIL:Ionl@sunergysystems.com <br /> CONTRACTOR LIC.#(REQUIRED):sunersi905d4 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 51574 <br /> PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-571-4726 <br /> Jon Lange CONTACT EMAIL:jonl©sunergysystems.com <br /> 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 <br /> 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 <br /> 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 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> 05/27/2020 <br /> E"Oh•- 047 <br /> Owner/A orized Agent Date (Revised 1/11/2019) Page 1-Application <br />