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11 <br />EVERETT <br />WASHINGTON <br />BUILDING PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review, <br />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) PermitSemices@everettwa.gov I (W) everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: STREET4628 W VIEW DR PARCEL#: 00605800002400 <br />c, EVERETT STATE WA zIP 98203 <br />SUITE/UNIT #: FLOOR M 1 ADDITIONAL LOCATION INFORMATION (if applicable): ROOF <br />TENANT/BUSINESS NAME (if non-residential): <br />LEGAL DESCRIPTION for new construction: Short Pladsubdivislon: Lot No.: (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME:ARLON D OWENSBY <br />OWNER MAILING STREET 4628 W VIEW DR <br />-ADDRESS: <br />cITY EVERETT srATE WA LP 98203 <br />OWNER PHONEA253152841 1OWNER <br />EMAIL: TIMETRAVLER163@YAHOO.COM <br />CONTRACTOR COMPANY NAME: <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />PRIMARY CONTACT: 0 OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />ARLON D OWENSBY <br />CONTACT PHONE:4253152841 <br />CONTACT EMAIL:TIMETRAVLER163@YAHOO.COM <br />BUILDING INFORMATION <br />VALUATION OF WORK: $45K 1ASSOCIATED LAND USE PROJECT # if applicable : <br />(Valuation shah inckide the prevailing fair mad et value of all labor, materials, and equipment needed to complete the work, whetheractua0ypaid or not.) <br />EXISTING USE OF BUILDING:SRF <br />PROPOSED USE OF BUILDING:SFR <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: ROOF MOUNTED SOLAR PANELS INSTALL <br />DESCRIPTION OF WORK: INSTALL PHOTOVOLTICA ROOF MOUNT SYSTEM <br />36 MODULES -ROOF MOUNT-13.14 KW DC <br />ACKNOWLEDGEMENT: I have reviewed this application and confirm the information contained herein is two 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. I am the owner, or I am authorized by the owner of this property to perform the work for which application is made, <br />and I comely with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # V D J <br />I <br />(Revised 412112022) U <br />