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EVERETT <br />WASHINGTON <br />A PERMIT APPLICATIO16 <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 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />Blue or Black Ink Only'Plea! PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS:1525 Hoyt Ave, Everett, WA, 98201 <br />PROPERTY TAX #: 00553632200900 <br />LEGAL for new construction: Short Plat/subdivision N/A Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: BELCHER DAVID TENANT BUSINESS NAME (Commercial): N/A <br />OWNER MAILING ADDRESS: STREET 1525 Hoyt Ave <br />crry Everett STATE WA zip 98201 <br />OWNER PHONE: (425) 252-8626 <br />OWNER EMAIL: belcherd@juno.com <br />CONTRACTOR NAME: Puget Sound Solar <br />CONTRACTOR ADDRESS: STREET 805 Rainier Ave S <br />cln, Seattle STATE WA ZIP 98144 <br />CONTRACTOR PHONE: (206) 706-1931 <br />1CONTRACTOR EMAIL: info@pugetsoundsolar.com <br />CONTRACTOR LICENSE #(REQUIRED): PUGETSS920RH <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 49544 <br />PRIMARY CONTACT: ❑ OWNER El CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />Lyudmila Arseniy <br />CONTACT PHONE: (206) 619-3818 <br />CONTACT EMAIL:larseniy@pugetsoundsolar.com <br />BUILDING INFORMATION <br />Existing Use of Building: SFR lContract <br />Price of Work: $ 17880.03 <br />Proposed Use of Building: SFR <br />Heat Source: ❑Gas ❑Electric []Other <br />BUILDING USE: ❑� SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ElAccessory Structure <br />Type of Project: ❑New ❑✓Addition ❑Remodel ❑Re air ❑T.I. ❑Sin ❑S rinkler ❑Demolition ❑Chan a of Use <br />DESCRIPTION OF WORK: Installation of rooftop Solar Photovoltaic System consisting of <br />(18) LG 370W b/w & (1) SolarEdge SE6000H-US <br />ASSOCIATED BUILDING PERMIT # if applicable): <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />A/C — Air Handling Units <br />Gas Piping <br />Backflow Preventer (Inside Bldg) <br />Shower, Tub, or Combo <br />Boiler <br />Gas Range <br />Clothes Washer <br />Sink -Commercial (3-comp,prep,floor) <br />Clothes Dryer <br />Heat Pump&Ductless <br />Dishwasher <br />Sink -Residential (kitchen, bath, bar) <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />Sink -Utility, laundry, mop <br />Exhaust Fans (Residential) <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type 11) <br />Water Heater <br />Interceptor -Grease <br />Waste/Water Piping Repair <br />Exhaust Hood (Residential) <br />Wood Stove <br />Interceptor-Sand/Oil <br />Water Service (behind meter) <br />Forced Air Systems <br />Other: <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplace/]nsert/Log <br />Roof Drains <br />Water Heater <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System I <br />INo. of Heads <br />Chemical Suppression System I <br />INo. 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 / comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />P In Z-0 _ © o <br />(Revised 10/10/2018) I I <br />