3202 LOMBARD AVE 2023-08-23 - Laserfiche WebLink

BUILDING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETTSUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review, WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT I NFORMATION: (P) 425-257-88101 (E) PermitServices@everettwa.gov I (W) everetwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 3202 Lombard Ave PARCEL #: 00439076403101 CITY Everett STATE WA Zp 98201 SUITEIUNIT #: FLOOR #: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME (if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: James L. Shlrlwasto OWNER MAILING ADDRESS: STREET 3202 Lombard Ave CITY Everett STATE WA Zp 98201 OWNER PHONE: (206) 306-4311 OWNER EMAIL: fiji22.jsw@gmall.com CONTRACTOR COMPANY NAME: SQlgen Power, LLC WA STATE CONTRACTOR LICENSE #(REQUIRED): SOLGEPL820BE CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 62231 CONTRACTOR ADDRESS: STREET 5715 Bedford St CITY Pasco STATE WA Ip 99301 CONTRACTOR PHONE: (506)394-4099 CONTRACTOR EMAIL: permitting@solgenpower.com PRIMARY CONTACT: ❑ OWNER ✓❑/1CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: Anissa Hernandez p 1 1 ICONTACT 99 CONTACT EMAIL:permttl g@solgenpower.com BUILDING INFORMATION VALUATION OF WORK: $ 5184 ASSOCIATED LAND USE PROJECT # (if applicable): (Valuation shall include the prevailing fair market value of all labor, materials, and equipment needed to complete the work, whether actually paid or not.) EXISTING USE OF BUILDING: SFR PROPOSED USE OF BUILDING: PV Solar Installation HEAT SOURCE: ❑Gas ❑✓ Electric ❑Other BUILDING TYPE: ✓❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family -# Units : ❑Commercial ❑Accessory Structure TYPE OF PROJECT (check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable ❑Re -roof ❑ Exterior Alteration ❑Tank (above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank (above ground) ❑✓ Other: PV SOLAR INSTALLATION DESCRIPTION OF WORK: PV SOLAR ROOF MOUNT INSTALLATION, 1 CIRCUIT, 4.320kW, MPU ACKNOWLEDGEMENT/ have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with 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 Building Official before being authorized under any circumstance. 1 am the owner, or 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 296.200A WAC. Aiv; sa Henlahclea 03/23/2023 Owner/Authorized Agent Signature Date City of Everett Official Use Only PERMIT # (Revised 4212022)