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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 1818 Summit Ave PARCEL #: 00563235302400 <br />CITY EVERETT STATE Washington ZIP 98201 <br />SulE/UNIT #: FLOOR M 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: Mitchell Sullivan <br />OWNER MAILING ADDRESS: STREET 1818 Summit Ave <br />CITY EVERETT STATE Washington zip 98201 <br />OWNER PHONE: '14252933164 <br />OWNER EMAIL: mitchsullivan3@gmail.com <br />CONTRACTOR COMPANY NAME: BRS Field Ops, LLC <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): BRSFIFO828M4 <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 60040 <br />CONTRACTOR ADDRESS: STREET 1403 N Research Way <br />CITY Orem STATE UT zip 84097 <br />CONTRACTOR PHONE: 385-482-0045 CONTRACTOR EMAIL: Permitting.department@blueravensolar.com <br />PRIMARY CONTACT: ❑ OWNER FNTRACTOR HER (Please Specify) <br />CONTACT NAME: <br />Carson Campbell <br />CONTACT PHONE: 385-482-0045 <br />CONTACT EMAIL: permitting.department@blueravensolar.com <br />BUILDING INFORMATION <br />VALUATION OF WORK: $ 5,304.94 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: <br />PROPOSED USE ILDI <br />HEAT SOURCE: s ctric er <br />BUILDING TYPE: R wnhouse lex U '-Family its: cial cessory Structure <br />T OF PRC�.I�rT (check at apply, w Construct' dition pair ange of Use <br />dular Urtable -roof rior Alteration nk (above ground) cessory Structure <br />nce over 7ft high ckStorage of/Hot Tub nk (above ground) er: PV Solar Array <br />DESCRIPTION OF WORK: <br />5.88 kW PV Solar Panel Installation on Roof <br />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 <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 1 am authorized by the owner of this property to perform the work for which application is made, <br />and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />c4 J ou c^a(pk& Permit Coordinator 07 / 19 / 2023 <br />Owner/Authorized Agent Signature Date <br />City of Everett Official Use Only <br />PERMIT # <br />(Revised 412112022) <br />