2021 JEFFERSON PL 2023-09-14 - Laserfiche WebLink

BUILDING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL 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 INFORMATION: (P)425-257-8810 1 (E)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 2021 Jefferson PI PARCEL#: 00512300000901 CITY Everett STATE WA zip 98203 SUITE/UNIT#: 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:Adam Schusted OWNER MAILING ADDRESS: STREET 2021 Jefferson PI CITY Everett STATE WA zip 98203 OWNER PHONE:(202) 210-8864 OWNER EMAIL: kelsey_Ilndstrom@yahoo.com CONTRACTOR COMPANY NAME:SOlgen 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 ZIP 99301 CONTRACTOR PHONE:(509) 394-4099 CONTRACTOR EMAIL:permitting@solgenpower.Com PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: LONTACT PHONE:(509) 394-4099 Solgen Power, LLC -Alysha McElwain NTACT EMAIL:permitting@solgenpower.com BUILDING INFORMATION VALUATION OF WORK: $10, 216.80 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:Single Family Home PROPOSED USE OF BUILDING:PV Solar roof mount installation HEAT SOURCE: [-]Gas ❑Electric ❑Other BUILDING TYPE: OSFR ❑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) Z10ther:PV SOLAR DESCRIPTION OF WORK: PV Solar Roof Mount Installation, 3 circuits, 11.88 kW ACKNOWLEDGEMENT.I 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.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only 02/27/2023 PERMIT# Owner/Authorized Agent Signature Date (Revised 4/21/2022)