1815 LOMBARD AVE 2023-04-11 - 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 1815 Lombard Avenue PARCEL #: 00438236400700 CITY Everett STATE WA zip 98201 SUITE/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: MACDONALD MATTHEW & KRISTIE OWNER MAILING ADDRESS: STREET 1815 Lombard Avenue CITY Everett STATE WA ZIP 98201 OWNER PHONE: (206) 265-0966 OWNER EMAIL: theclasslcmatt@gmall.com CONTRACTOR COMPANY NAME: Lumlo WA STATE CONTRACTOR LICENSE #(REQUIRED): LUM10H1789KR CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 64332 CONTRACTOR ADDRESS: STREET 2500 Mottman Rd SW Suite 100 CITY Tumwater STATE WA Zlp 98512 CONTRACTOR PHONE:360.637.4343 1CONTRACTOR EMAIL: pnw•permitting@lumlo.com PRIMARY CONTACT: ❑ OWNER NCONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: Jesus Familia CONTACT PHONE: 360.464.2344 CONTACT EMAIL: pnw.permitting@lumio.com BUILDING INFORMATION VALUATION OF WORK: $ 4,320 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: Residential PROPOSED USE OF BUILDING: No Change HEAT SOURCE: ❑Gas ❑Electric ❑Other NA BUILDING TYPE: VSFR ❑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 ❑Exterior Alteration ❑Tank (above ground) �/❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank (above ground) other: Rooftop Solar Installation DESCRIPTION OF WORK: 3.60 KWDC Rooftop Photovoltaic Solar Installation // 2.70KWAC 9 Q CELLS Q.PEAK DUO BLK ML-G10+ (400W) MODULES 9 ENPHASE IQ8PLUS-72-2-US (240V) MICROINVERTERS ACKNOWLEDGEMENT.' 1 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. 1 am the owner, or 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 296.200A WAC. Fdm��d Agent Signature Date City of Everett Official Use Only PERMIT # 22 (Revised 21812021)