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BUILDING PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT <br /> SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review, <br /> WASHINGTON 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)PermitServices@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 2417 101St St SE PARCEL#: 00817400000600 <br /> clrY Everett STATE WA ZIP 98208 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Marie E Kiekhaefer& Matt Kraske <br /> OWNER MAILING ADDRESS: STREET 2417 101st St SE <br /> CITY Everett STATE WA zIP 98208 <br /> OWNER PHONE:(509)429-4367 OWNER EMAIL: mattkraske@gmail.com <br /> CONTRACTOR COMPANY NAME:A AND R SOLAR SPC <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):RSOLAS*903JM CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 53961 <br /> CONTRACTOR ADDRESS: STREET 3211 MLK Jr Way S, Suite B <br /> CITY Seattle STATE WA ZIP 98144 <br /> CONTRACTOR PHONE:206-707-9937 office CONTRACTOR EMAIL:permits@a-rsolar.com <br /> PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:360-621-8238 Cell <br /> Wendy Wenrick CONTACT EMAIL:permits@a-rsolar.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $4365.90 ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING:SFR <br /> PROPOSED USE OF BUILDING: <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: <br /> DESCRIPTION OF WORK: <br /> Installing 8.61 kW DC, 7.60 kW AC PV system on rooftop. <br /> ACKNOWLEDGEMENT.1 have reviewed this application and confirm the information contained herein is true 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.1 am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ��/'� 06/09/2023 PERMIT# <br /> why We�ujc <br /> Owner/Authorized Agent Signature Date (Revised 4/21/2022) <br />