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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 1(E)PermitServices@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:5501 Wetmore Ave Everett, Washington 98203 BUILDING AREA: sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑✓ ADDITION ❑TENANT IMPROVMENT []REMODEL <br /> BUILDING USE: ❑✓ SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIA <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK: $6,240 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: 5.20kWDC Rooftop Photovoltaic Solar Installation <br /> 5.20kWDC Rooftop Photovoltaic Solar Installation <br /> 13 Q CELLS Q.PEAK DUO BLK ML-G10+ (400W) MODULES <br /> 13 ENPHASE IQ8PLUS-72-2-US (240V) MICROINVERTERS <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: ❑Service ❑Feeder ❑Circuits-#: 1 ❑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 <br /> additional Fire Alarm Permit is required for review of device location and installation approval. <br /> ❑Other(List All): <br /> CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ✓ NO LJ YES--See Below&Pg. 2 <br /> By checking this box, I am stating that I have read and understand all of WAC 296-4613-900,selected the specific reason on page <br /> 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 <br /> See Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:[Z]NO []YES-See Below&Pg. <br /> ElPursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or lease <br /> 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:SCHILLEN JENNIFER JEAN TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5501 Wetmore Ave <br /> CITY Everett STATE WA ZIP 98203 <br /> OWNER PHONE:(425)239-7989 OWNER EMAIL:1•schillen@mac.com <br /> CONTRACTOR NAME: Lumlo <br /> CONTRACTOR ADDRESS: STREET2500 Mottman Rd SW Suite 100 <br /> CITY Tumwater STATE WA op 98512 <br /> CONTRACTOR PHONE:360-777-6681 CONTRACTOR EMAIL:DnW.permittinq(@Iumio.Com <br /> CONTRACTOR LIC.#(REQUIRED):LU IVI 11.11--1 1104 N4 ICITY OF EVERETT BUSINESS LIC.#(REQUIRED): b4.S.SL <br /> PRIMARY CONTACT: DOWNER OCONTRACTOR E]OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:360-777-6681 <br /> Jesus Familia CONTACT EMAIL: gnW.germlttlnalwlumlo.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 <br /> or local law regulating construction or the performance of construction. That 1 am authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> EF <br /> 11/10/2022 <br /> ner/Authorized Agent Signature Date (Revised 4/5/2022) Page 1-Application <br />