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BUILDING PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT <br /> SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review, <br /> WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> CONTACT INFORMATION: (P)425.257.8810 1 (E)everetteps@everettwa.gov I (W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 1502 McDougall Avenue PARCEL#: 00475431403100 <br /> cITY Everett STATE WA zip 98201 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: HOLMES AUSTIN\MANKA MARGARET <br /> OWNER MAILING ADDRESS: STREET 1502 McDougall Avenue <br /> CITY Everett STATE WA ZIP 98201 <br /> OWNER PHONE: (425) 775-7629 OWNER EMAIL: margaret.man ka@gmail.COm <br /> CONTRACTOR COMPANY NAME: Lurnio <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):LUMI0HI789KR CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 64332 <br /> CONTRACTOR ADDRESS: STREET 2500 Mottman Rd SW Suite 100 //�� <br /> CITY Tumwater STATE WA ZIP 98512 <br /> CONTRACTOR PHONE:360.637.4343 CONTRACTOR EMAIL: pnw.permitting@lumio.com <br /> PRIMARY CONTACT: ❑OWNER VICONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:360.464.2344 <br /> Jesus Familia CONTACT EMAIL:pnw.permitting@lumio.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $9,600 ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING:Residential <br /> PROPOSED USE OF BUILDING:No Change <br /> HEAT SOURCE: [-]Gas ❑Electric ❑Other NA <br /> BUILDING TYPE: VSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition [-]Remodel [-]Repair ❑T.I. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration [-]Tank(above ground),�/❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub [-]Tank(above ground) mother: Rooftop Solar Installation <br /> DESCRIPTION OF WORK: <br /> 8.00kWDC Rooftop Photovoltaic Solar Installation//6.00 KWAC <br /> 20 Q CELLS Q.PEAK DUO BLK ML-G10+ (40OW) MODULES <br /> 20 ENPHASE IQ8PLUS -72-2-US (240V) MICROINVERTERS <br /> 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 <br /> 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 <br /> 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, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> // PERMIT# <br /> 11/14/2022 <br /> ner/Authorized Agent Signature Date (Revised 2/8/2021) <br />