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1930 JACKSON AVE 2023-08-23
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1930 JACKSON AVE 2023-08-23
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Last modified
8/23/2023 3:41:32 PM
Creation date
8/22/2023 7:20:49 AM
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Address Document
Street Name
JACKSON AVE
Street Number
1930
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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:1930 Jackson Avenue Everett, Washington 98203 BUILDING AREA: sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION Z ADDITION ❑TENANT IMPROVMENT ❑REMODEL <br /> BUILDING USE: ❑✓ SFR []TOWNHOUSE ❑ DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK:$6,720 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: 5.60kW Rooftop Photovoltaic Solar Installation//4.200 kWAC//Main Service Panel Upgrade <br /> 5.60kW Rooftop Photovoltaic Solar Installation//4.200 kWAC H Main Service Panel Upgrade <br /> 14 Q CELLS Q.PEAK DUO BLK ML-G10+ (400W) MODULES <br /> 14 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-#:-I ❑Complete Re-wire <br /> LOW VOLTAGE WORK? Q 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 COMPLIANC <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:CAMPBELL NINETTE C TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1930 Jackson Avenue <br /> ,,n Everett STATE WA Z,P 98203 <br /> OWNER PHONE:(425)268-8598 OWNER EMAIL:marinermama51@yahoo.com <br /> CONTRACTOR NAME:Lumlo <br /> CONTRACTOR ADDRESS: STREET2500 Mottman Rd SW Suite 100 <br /> CITY Tumwater STATE WA 1,98512 <br /> CONTRACTOR PHONE:360-777-6681 ICONTRACTOR EMAIL:pnW.permittina(@_Iumio.Com <br /> CONTRACTOR LIC.#(REQUIRED):LU IVI I U"I /0411N-4 ICITY OF EVERETT BUSINESS LIC.#(REQUIRED): 04.53L <br /> PRIMARY CONTACT: DOWNER OCONTRACTOR ❑OTHER(Please Specify) Q <br /> CONTACT NAME: CONTACT PHONE:360-777-6681 <br /> Jesus Familia CONTACT EMAIL:pnW.permittina(@Iumio.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 I am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> EE7 <br /> #: <br /> �a�� 03/21/2023 <br /> 001 er/Authorized Agent Signature Date (Revised 4/5/2022) Page 1-Application <br />
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