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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) PermitServices@everettwa.gov I (W) everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: STREET 21 E McGill Ave PARCEL #: 00480200800200 <br />CITY Everett STATE WA zlp 98208 <br />SulE/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: Paula Hollcraft <br />OWNER MAILING ADDRESS: STREET 21 e Mcgill Ave <br />CITY Everett STATE WA zlp 98208 <br />OWNER PHONE:4253533738 <br />OWNER EMAIL: phollcraftl6@gmail.com <br />CONTRACTOR COMPANY NAME: Revolution Energy Systems <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): REVOLES7881-7 <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 6049157460010001 <br />CONTRACTOR ADDRESS: STREET4425 100st SW Suite H <br />CITY Lakewood STATE WA ZIP 98499 <br />CONTRACTOR PHONE: 8016907047 <br />CONTRACTOR EMAIL: permits.wa@revolutionsolar.com <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑✓ OTHER (Please Specify) Courtney, Permit Coordinator <br />CONTACT NAME: <br />Courtney <br />CONTACT PHONE:8016907047 <br />CONTACT EMAIL: ccall@revolutionsolar.com <br />BUILDING INFORMATION <br />VALUATION OF WORK: $ 82988 <br />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 home <br />PROPOSED USE OF BUILDING: Residential home <br />HEAT SOURCE: ❑Gas ❑Electric ❑Other <br />BUILDING TYPE: ❑✓ SFR ❑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) ❑✓ Other: Photovoltaic system <br />DESCRIPTION OF WORK: <br />Roof mount Solar array, grid tied. AC system size: 9.75kW DC system size- 14.40kW <br />(30) Hanwha Q.PEAK DUO XL-G10.2 480 PV Modules. (30) Enphase IQ8M-72-2-US <br />(240V) Inverters <br />ACKNOWLEDGEMENT: l 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. l am the owner, or l am authorized by the owner of this property to perform the work for which application is made, <br />and/ comply with the State Contractors Law 18.27 RCW and 296.200A WA C. <br />12/1 /22 <br />Owner/Authorized- Agent Signature Date <br />City of Everett Official Use Only <br />PERMIT # <br />(Revised 412112022) <br />