1301 RUCKER AVE 2023-01-09 - Laserfiche WebLink

i ELECTRICAL PERMIT APPLICATION EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everetlwa.gov I www.everettwa.gov/permi(s PROJECT SITE INFORMATION PROJECT ADDRESS: 1301 Rucker Ave IBUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ✓❑TENANT IMPROVMENT ❑ REMODEL_ BUILDING USE: ❑✓ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICAL.APPLICATION INFORMATION;& DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 15047 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: installation of 37 rooftop photovoltaic modules- (Model: Silfab 38013K), with 37 Micor-inverters: (Model: Enphase IQ7+) THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL.THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: ❑Service 0 Feeder ❑✓ Circuits-#:2 ❑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 Ail):photovoltaic, subpanel,EV charger CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ✓ NO YES See Below&Pg.2 By checking this box, I am stating that I have read and understand all of WAC 296.466-900,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: ✓NO YES-See Below&Pg.3 ❑ 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''INFORMATION OWNER NAME: Nancy Cooper TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: sTREET 1301 Rucker Ave ern Everett STATE WA ZIP 98201 OWNER PHONE:4255082696 1OWNER EMAIL:jerry@greeningamerica.net CONTRACTOR NAME: Sunergy Systems Inc. CONTRACTOR ADDRESS: S111EET4546 Leary Way NW cnv Seattle STATE WA ziP 98107 CONTRACTOR PHONIz:2065714726 1CONTRACTOR EMAIL:jonl@sunergysystems.com CONTRACTOR LIC.#(REQUIRED):sunersi905d4 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):51574 PRIMARY CONTACT: DOWNER RICONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:2065714726 Jon Lange ICONTACTEMAIL:jonl@sunergysystems.com AGREEMENT.,t hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of taws and ordinances governing this type of work will be completed whether specirted 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 l am authorized by the owner of this property to perform the work for which application is made and! comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PEFRMIT#: 11/6/2022 Au o ize Agent Slg at Date {Revised 1/11/2019) Page 1-Application r/ n