1615 LOMBARD AVE 2023-10-31 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1(E)PermitServices@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:1615 Lombard Avenue Everett, Washington 98201 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑✓ ADDITION F1 TENANT IMPROVMENT []REMODEL BUILDING USE: ❑✓ SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $18,800 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: 8.00kWDC Rooftop Photovoltaic Solar Installation 8.00kWDC Rooftop Photovoltaic Solar Installation 20 Q CELLS Q.PEAK DUO BLK ML-G10+ (40OW) MODULES 20 ENPHASE IQ8PLUS-72-2-US (240V) MICROINVERTERS THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑✓ NO [I YES-Select Scope: ❑Service ❑Feeder ❑Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? ✓❑NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data ❑Intercom ❑Thermostat ❑Audio ❑Secure Access Security System ❑Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional Fire Alarm Permit is required for review of device location and installation approval. ❑✓ Other(List All):Solar Installation CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ✓ NO LJ YES--See Below&Pg. 2 By checking this box, I am stating that I have read and understand all of WAC 296-4613-900,selected the specific reason on page 2 of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:[Z]NO []YES-See Below&Pg. ElPursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or lease without the proper electrical licensing and certification, or exemption. By checking this box, I am stating that I have completed and See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME:OTERO .JOSHUA TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1615 Lombard Avenue CITY Everett STATE WA ZIP 98201 OWNER PHONE:(425)625-3450 OWNER EMAIL:joshua.adam.otero@outlook.com CONTRACTOR NAME:Lumio CONTRACTOR ADDRESS: STREET 2500 Mottman Rd SW Suite 100 CITY Tumwater STATE WA op 98512 CONTRACTOR PHONE:360-777-6681 CONTRACTOR EMAIL:pnw.permitting@lumio.com CONTRACTOR LIC.#(REQUIRED):LUM10H1789KR ICITY OF EVERETT BUSINESS LIC.#(REQUIRED): 52463 PRIMARY CONTACT: DOWNER ❑✓ CONTRACTOR E]OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this 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 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 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only EF 10/25/2022 Owner/Authorized Agent Signature Date (Revised 4/5/2022) Page 1-Application