4920 COLBY AVE 2023-11-28 - Laserfiche WebLink

BUILDING PERMIT APPLICATION EVERETT CITY OF SERVICES SUBMITTAL INSTRUCTIONS:See applicable submittal ;I.-,;Kllst for submittal requirements and number of copies required for review, WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION:(P)425-257-8810 1(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 4920 Colby Avenue Everett WA 98203 PARCEL M 00386300002100 clTr Everett STATE WA ZIP 98203 SUITE/UNIT#: n/a FLOOR#: n/a ADDITIONAL LOCATION INFORMATION (if applicable), n/a TENANT/BUSINESS NAME(if non-reside d LEGAL DESCRIPTION for new conz'r,ct ort Platisubdivision: n/a Lot No.: n/a (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Jason J Goodrich OWNER MAILING ADDRESS: STREET 4920 Colby Avenue clTy Everett STATE WA ZIP 98203 OWNER PHONE:(425) 737-9510 OWNER EMAIL: danisue55@hotmail.com CONTRACTOR COMPANY NAME:Solgen Power, LLC WA STATE CONTRACTOR LICENSE#(REQUIRED):SOLGEPL820BE CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 62231 CONTRACTOR ADDRESS: STREET5715 Bedford St. clTv PascO STATE WA ZIP 99301 CONTRACTOR PHONE:(509)394-4099 CONTRACTOR EMAIL:permitting@solgenpower.com PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:(509)394-4099 Ingrid Lo m e ra CONTACT EMAIL:permitting@solgenpower.com BUILDING INFORMATION VALUATION OF WORK:$6,318 ASSOCIATED LAND USE PROJECT#(if applicable):n/a (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING:residence PROPOSED USE OF BUILDING:PV solar roof mount installation HEAT SOURCE: ❑Gas ❑✓Electric ❑Other BUILDING TYPE: ❑✓SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable ❑Re-roof ❑Exterlor Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑PooUHot Tub ❑Tank(above ground) ❑✓Other:PV solar roof mount installation DESCRIPTION OF WORK: PV Solar Roof Mount Installation, 2 circuits, 5.265kw 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 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 Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application Is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Oficial Use Only 10/06/23 PERMIT# Owner/Authorized Agent Signature Date (Revised 4/21/2022)