401 PECKS DR 2025-04-18 - Laserfiche WebLink

BUILDING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETTSUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review, WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION: (P) 425.257.8810 1 (E) everetteps@everettwa.gov I (W) everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 401 Pecks Dr PARCEL #: 00541900000405 cITY Everett STATE Washington ZIP 98203 SulE/UNIT #: FLOOR #: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME (if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Ron Bevins OWNER MAILING ADDRESS: STREET 401 Pecks Dr. CITY Everett, STATE Washington ZIP 98203 OWNER PHONE: 509-307-6618 OWNER EMAIL: rbevins2003@yahoo.com CONTRACTOR COMPANY NAME: Blossom Solar WA STATE CONTRACTOR LICENSE #(REQUIRED): BLOSSSL823M7 CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 57621 CONTRACTOR ADDRESS: STREET 1706 Lombard Ave CITY Everett STATE Washington ZIP 98201 CONTRACTOR PHONE: 425-610-7067 CONTRACTOR EMAIL: office@blossomsolar.com PRIMARY CONTACT: ❑ OWNER k] CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: Weston Ferguson CONTACT PHONE: 425-760-1603 CONTACT EMAIL:weston@blossomsolar.com BUILDING INFORMATION VALUATION OF WORK: $ 27,250.00 ASSOCIATED LAND USE PROJECT # (if applicable): (Valuation shall include the prevailing fair market value of all labor, materials, and equipment needed to complete the work, whether actually paid or not.) EXISTING USE OF BUILDING: Single Family Residence PROPOSED USE OF BUILDING: HEAT SOURCE: ❑Gas ❑Electric ❑Other BUILDING TYPE: OSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT (check all that apply) : ❑New Construction ❑Addition ❑Remodel [-]Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable ❑Re -roof El Exterior Alteration ❑Tank (above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank (above ground) Z10ther: Solar DESCRIPTION OF WORK: Installing 10.26 kW Grid Tied Roof Mounted Solar Array 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 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 Building Official before being authorized under any circumstance. I am the owner, or 1 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 296.200A WAC. Weston Ferguson OD.tte 202t;2201437,12-0800' 12/20/2021 Owner/Authorized Agent Signature Date City of Everett Official Use Only PERMIT # (Revised 21812021)