3120 19TH ST 2022-12-21 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1(E)PermitServices@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:3120 19th St, Everett, WA 98201 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT s❑REMODEL BUILDING USE: s❑SFR []TOWNHOUSE ❑ DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICAL APPLICATION INFORMATION 8r, DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $18,894 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Install 8.19kW grid-tied, roof-mounted solar PV system at a single family residence. Install 8.19kW grid-tied, roof-mounted solar PV system at a single family residence. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO OYES-Select Scope:❑Service s❑Feeder ❑Circuits-#: 1 ❑Complete Re-wire LOW VOLTAGE WORK? 0 NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data ❑Intercom ❑Thermostat ❑Audio ❑Secure Access In 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):Solar CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: El NO LJ YES--See Below&Pg.2 ❑ By checking this box, I am stating that I have read and understand all of WAC 296-46113-900,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. E] 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:Jamle Graninger TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 3120 19th St ,,T, Everett STATE WA ziR 98201 OWNER PHONE:334-470-3253 OWNER EMAIL:1•a.graninger@gmail.com CONTRACTOR NAME:Forecast Roofing & Solar CONTRACTOR ADDRESS: STREET 12820 Avondale Way c,Ty Everett STATE WA 1,98204 CONTRACTOR PHONE:425-487-6000 CONTRACTOR EMAIL:office@forecastsolar.COm CONTRACTOR LIC.#(REQUIRED):FORECRS883DG CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 044167 PRIMARY CONTACT: [—]OWNER °❑CONTRACTOR F]OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-487-6000 Will H a be n i c h t CONTACT EMAIL:office@forecastsolar.com AGREEMENT:I hereby certify that/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 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only EE Digitally signed Will Halbenicht Will Habenicht Date:022.10.3n109:0504 0700' 10/31/2022 Owner/Authorized Agent Signature Date (Revised 4/5/2022) Page 1-Application