2005 75TH ST SE 2023-07-31 - Laserfiche WebLink

DocuSign Envelope ID: 18AOC803-21C8-43E5-9401-2C1808ADA96E ELECTRICAL PERMIT APPLICATION EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 2005 75th st se Everett Washington 98203 BUILDING AREA: sq ft PROJECT TYPE: VNEW CONSTRUCTION WADDITION ❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 8531.20 1ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: PV Solar Roof Mount THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY LINE VOLTAGE WORK? ❑ NO 9YES-Select Scope: ❑ Service VFeeder Circuits-#: 3 ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑ Audio ❑ Secure Access ❑ Security System ❑ Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional ,Hire/Alarm Permit is required for review of device location and installation approval. LJ Other(List All): PV Solar Roof Mount CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: NO Ll YES--See Below&Pg. 2 ❑ By checking this box, I am stating that I have read and understand all of WAC 296-46113-900,selected the specific reason on page 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 See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: MINO ❑YES-See Below&Pg.3 ❑ Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale,or lease without the proper electrical licensing and certification, or exemption. By checking this box, I am stating that I have completed and See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME: Rodney Gust TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 2005 75th st se CITY Everett STATE WA zip 98203 OWNER PHONE: (425) 903-6803 OWNER EMAIL: rodney.I.gust@gmall.com CONTRACTOR NAME:Solgen Power CONTRACTOR ADDRESS: STREET 5715 Bedford St CITY Pasco STATE WA Z,p 99301 CONTRACTOR PHONE:5098664302 CONTRACTOR EMAIL:)oseph.astudlllo@solgenpower.com CONTRACTOR LIC.#(REQUIRED):SOLGEPL830RJ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: DOWNER YrCIONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 5098664302 Joseph Astudillo CONTACT EMAIL:Joseph.astudlllo@SOlgenpower.com AGREEMENT:/hereby certify that/have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this 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 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 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: 4/7/2021 E ,,*Iner/Af6thorized Agent Signature Date (Revised 1/11/2019) Page 1-Application