614 DEXTER AVE 2023-04-04 - 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 614 Dexter Ave PARCEL #: 00443100002902 cITY Everett STATE WA 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: Tom L Cook & Lori T Hughes OWNER MAILING ADDRESS: STREET 614 Dexter Ave CITY Everett STATE WA ZIP 98203 OWNER PHONE:425-359-5377 OWNER EMAIL: feylinsong@gmail.com CONTRACTOR COMPANY NAME:Blossom Solar WA STATE CONTRACTOR LICENSE #(REQUIRED): BLOSSSL823M7 I CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 57621 CONTRACTOR ADDRESS: STlEET1706 Lombard Ave CITY Everett STATE WA zip 98201 CONTRACTOR PHONE:425-610-7067 1CONTRACTOR EMAIL: office@blossomsolar.Com PRIMARY CONTACT: ❑ OWNER 0 CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: Madison Martinez CONTACT PHONE:425-610-7067 CONTACT EMAIL: office@blossomsolar.com BUILDING INFORMATION VALUATION OF WORK: $ $50,201.28 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: 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: Photo Voltaic Solar DESCRIPTION OF WORK: 10.93 kW grid tied roof mounted solar system 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. mod is� &. M"ftze Owner/Authorized Agent Signature July 26, 2022 Date City of Everett Official Use Only PERMIT # (Revised 21812021)