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ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P) 425-257-8810 1 (E) Perm itSewices@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION TIE PROJECTADDRESS: 212661STST SE, Everett, Washington, 98203 BUILDING AREA: 409.0 sgft PROJECT TYPE: ❑ NEW CONSTRUCTION ADDITION ❑TENANT IM PROVMENT ❑ REMODEL BUILDING USE: [2SFR ❑TOWNHOUSE []DUPLEX ❑ADU ❑MULTI -FAMILY -#OF UNITS: ❑COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 7578.49 ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK: 8.4 kW PV Solar Panel Installation on Roof-- 20 panels THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El No ❑YES - Select Scope:❑Service ❑Feeder ❑Circuits-#: 2 [—]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 Fire Alarm Permit is required for review of device location and installation approval. ❑ Other (List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: 2NO YES -- See Below & Pg. 2 ElBy checking this box, I am stating that I have read and understand all of WAC 296-4613-900, 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: O LJYES -See Below & Pg. ❑ 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: WAVIER PEREZ TENANT BUSINESS NAME If Commercial): OWNER MAILING ADDRESS: STREET 212661 ST ST SE, Everett, Washington, CITY Everett STATE Washington Zp 98203 OWNER PHONE: +14252329654 OWNER EMAIL: HORIZON_AUTOS@YAHOO.COM CONTRACTOR NAME: BRS Field Ops, LLC CONTRACTOR ADDRESS: STREET 1403 N Research Way CITY Orem STATE UT ➢P 84097 CONTRACTOR PHONE: 385-482-0045 CONTRACTOR EMAIL: permitting.department@blueravensolar.com CONTRACTOR LIC. #(REQUIRED): 3RSFIFO820N3 CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 60040 PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: Hayden Low CONTACT PHONE: 385-482-0045 CONTACT EMAIL: Permitting.department@blueravensolar.com AGRLLMhN l: 1 hereby certrty that 1 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/ am authorized by the owner of this property to perform the work for which application is made and/ comply with the State Contractors Law 18.27 RCW and 296.200 WAC. Cityof Everett Official Use Only / PE ##4Gi'2k LOW 06 / 21 / 2023 FRMIT #: ` Owner/Authorized Agent Signature Date (Revised 4/52022) Page 1-Application