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BUILDING PERMIT APPLICATION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <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 206 W MARILYN AVE PARCEL#: 00480200702603 <br /> CITY EVERETT STATE Washington ZIP 98204 <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: WILLY HUTABARAT <br /> OWNER MAILING ADDRESS: STREET 206 W MARILYN AVE <br /> CITY EVERETT STATE Washington zip 98204 <br /> OWNER PHONE: +14253506028 OWNER EMAIL: wshutabarat@gmail.com <br /> CONTRACTOR COMPANY NAME: BRS Field Ops,LLC <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): BRSFIF0828M4 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 � NTRACTOR HER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 385482-0045 <br /> Lacy Holliday CONTACT EMAIL: <br /> permitting.department@blueravensofar.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: 4547.09 ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall Include the preva ing fair market val of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDI <br /> PROPOSED USE ILDI <br /> HEAT SOURCE: s ctric er <br /> BUILDING TYPE: R nhouse lex U -Family- its: cial cessory Structure <br /> OF PRCZJ,F1,T(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 oVHot Tub nk(above ground) er:_ PV SolarArrav <br /> DESCRIPTION OF WORK: <br /> 5.04 kW PV Solar Panel Installation on Roof-12 panels <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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> R�Qy Permit Coordinator 09/11/2023 P MIT# � ` <br /> Owner/Authorized Agent Signatuure Date (Revised 4/21 2022) �1` <br />