Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
ELECTRICAL PERMIT APPLICATION <br /> EVERETT 32CITY OF EVERETT PERMIT SERVICES <br /> 00 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 2021 Jefferson PI, Everett WA, 98203 1 BUILDING AREA: sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ✓❑ ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: s❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK: $ 10, 216.80 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> PV Solar Roof Mount Installation, 3 circuits, 11.88 kW <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑ NO ❑YES-Select Scope: ❑ Service ❑ Feeder s❑ Circuits-#:3 ❑ Complete Re-wire <br /> LOW VOLTAGE WORK? ✓❑ NO ❑YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑ Audio ❑ Secure Access ❑ Security System <br /> ❑ Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional <br /> Fire Alarm Permit is required for review of device location and installation approval. <br /> s❑ Other(List All): PV Solar <br /> CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: 71 NO Ll YES--See Below&Pg. 2 <br /> ❑ By checking this box, I am stating that I have read and understand all of WAC 296-46113-900,selected the specific reason on page 2 <br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not <br /> See Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ✓❑NO —]YES-See Below&Pg.3 <br /> ❑ Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease <br /> without the proper electrical licensing and certification, or exemption. By checking this box, I am stating that I have completed and <br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> CONTACT INFORMATION <br /> OWNER NAME: Adam SChusted TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2021 Jefferson PI <br /> ,,, Everett STATE WA 1, 98201 <br /> OWNER PHONE:(202) 210-8864 OWNER EMAIL:kelsey_Ilndstrom@yahoo.Com <br /> CONTRACTOR NAME: SOlgen Power, LLC <br /> CONTRACTOR ADDRESS: ITIEET5715 Bedford St <br /> CITY Pasco STATE WA ZIP 99301 <br /> CONTRACTOR PHONE:(509) 394-4099 CONTRACTOR EMAIL:permitting@solgenpower.com <br /> CONTRACTOR LIC.#(REQUIRED):SOLGEPL820BE CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 62231 <br /> PRIMARY CONTACT: DOWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:(509) 394-4099 <br /> Solgen Power,LLC-Alysha McElwain <br /> CONTACT EMAIL:permitting@solgenpower.com <br /> AGREEMENT:/hereby certify that/have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br /> 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 <br /> local law regulating construction or the performance of construction. That 1 am authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> E <br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />