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ELECTRICAL PERMIT APPLICATION <br />EVERETT <br />WASHINGTON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: 3507 Oakes Ave <br />BUILDING AREA: 2,000 sq ft <br />PROJECT TYPE: ❑ NEW CONSTRUCTION ✓❑ ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL <br />BUILDING USE: s❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: ❑ COMMERCIAL <br />ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br />CONTRACT PRICE OF WORK: $ 4,773 <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIBE SCOPE OF WORK: <br />PV SOLAR ROOF MOUNT INSTALLATION, 2 CIRCUITS, 5.55kW <br />THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br />LINE VOLTAGE WORK? ❑ NO ❑ YES - Select Scope: ❑ Service ❑ Feeder ✓❑ Circuits-#: 2 ❑ Complete Re -wire <br />LOW VOLTAGE WORK? ✓❑ NO ❑ YES- # of Devices: <br />SELECT SCOPE (REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑ Audio ❑ Secure Access ❑ Security System <br />❑ Fire Alarm - Installations under this permit only include electrical wiring rough -in of the system. An additional <br />Fire Alarm Permit is required for review of device location and installation approval. <br />✓❑ Other (List All): PV SOLAR ROOF MOUNT INSTALLATION <br />CODE COMPLIANCE <br />IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: 71 NO Ll YES -- See Below & Pg. 2 <br />By checking this box, I am stating that I have read and understand all of WAC 296-46B-900, selected the specific reason on page 2 <br />of this application (see next page), AND Plan Review is NOT required because I meet all of the following sub sections that do not <br />See Page 2 require Plan Review. <br />ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ✓❑NO ❑YES -See Below & Pg. 3 <br />Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or lease <br />ZI without the proper electrical licensing and certification, or exemption. By checking this box, I am stating that I have completed and <br />See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br />CONTACT INFORMATION <br />OWNER NAME: Michael Lee TENANT BUSINESS NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET 3507 Oakes Ave <br />c,T,, Everett STATE WA zIP 98201 <br />OWNER PHONE: (530)906-2676 <br />OWNER EMAIL: michael.je.lee@protonmail.com <br />CONTRACTOR NAME: SOlgen Power, LLC <br />CONTRACTOR ADDRESS: ITIEET5715 Bedford St <br />CITY Pasco STATE WA ZIP 99301 <br />CONTRACTOR PHONE: (509)394-4099 <br />CONTRACTOR EMAIL: permitting@solgenpower.com <br />CONTRACTOR LIC. #(REQUIRED): SOLGEPL820BE <br />CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 62231 <br />PRIMARY CONTACT: DOWNER OCONTRACTOR ❑OTHER (Please Specify) <br />CONTACT NAME: <br />Anissa Hernandez <br />CONTACT PHONE: (509)394-4099 <br />CONTACT EMAIL: permitting@solgenpower.com <br />AGREEMENT: I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br />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 <br />local law regulating construction or the performance of construction. That/ am authorized by the owner of this property to perform the work for which application is made and/ <br />comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br />PERMIT #: <br />,4 4Wa 1�0-i1ano(2z 01/30/2023 E <br />Owner/Authorized Agent Signature Date (Revised 1/1112019) Page 1-Application <br />