2802 16TH ST 2023-06-27 - Laserfiche WebLink

BUILDING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL 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)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 2802 16th St. PARCEL M 00576432900100 CITY Everett STATE WA zlp 98201 SUITE/UNIT M FLOOR M 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:John Chubinsky OWNER MAILING ADDRESS: STREET 2802 16th St. CITY Everett STATE WA zip 98201 OWNER PHONE:503-739-2822 OWNER EMAIL: johnchubinsky@gmail.com CONTRACTOR COMPANY NAME:Revolution Energy Systems, Inc. WA STATE CONTRACTOR LICENSE#(REQUIRED):REVOLES7881-7 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6049157460010001 CONTRACTOR ADDRESS: STREET 4425 100s SW Suite H CITY Lakewood STATE WA ZIP 98499 CONTRACTOR PHONE:8016907047 CONTRACTOR EMAIL:permits.wa@revolutionsolar.com PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) Nick,Permit Coordinator CONTACT NAME: CONTACT PHONE:801-877-6842 Nick Lansfeldt CONTACT EMAIL:nlansfeldt@revolutionsolar.com BUILDING INFORMATION VALUATION OF WORK: $24,283.23 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:Residential 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 ❑Exterior Alteration [-]Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) Z10ther:Rooftop Solar Array DESCRIPTION OF WORK: Roof mount; grid tied; residential solar array. AC System Size: 3.90 W. DC System Size: 5.40 kW. (12) Canadian Solar CS3W-450 MS (450W) PV Modules, (12) Enphase IQ8M-72-2-US (240V) Inverters. 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. City of Everett Official Use Only 1 /9/23 PERMIT# Owner/Authorized Agent Signature Date (Revised 4/21/2022)