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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)everetteps@everettwa.gov I (W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 5101 Wilmington Ave PARCEL#: 00410200008200 <br /> CITY Everett STATE WA zip 98203 <br /> SUITE/UNIT#: na FLOOR#: na ADDITIONAL LOCATION INFORMATION (if applicable): na <br /> TENANT/BUSINESS NAME(if non-residential):na <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: na Lot No.: na (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Michael Wallace <br /> OWNER MAILING ADDRESS: STREET 5101 Wilmington Ave <br /> CITY Everett STATE WA Zip 98203 <br /> OWNER PHONE:425-210-1004 OWNER EMAIL: littlewalle@gmail.com <br /> CONTRACTOR COMPANY NAME:Solgen Power LLC <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):SOLGEPL820BE CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 62231 <br /> CONTRACTOR ADDRESS: STREET 5715 Bedford St <br /> CITY Pasco STATE WA Zip 99301 <br /> CONTRACTOR PHONE:509-931-1663 CONTRACTOR EMAIL:permitting.wa@solgenpower.com <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:509-931-1663 <br /> Isabel Casillas CONTACT EMAIL:permitting.wa@Solgenpower.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $14860.80 ASSOCIATED LAND USE PROJECT#(if applicable):na <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:Residence <br /> PROPOSED USE OF BUILDING:PV Solar Roof Mount installation <br /> HEAT SOURCE: [-]Gas DElectric DOther n/a <br /> BUILDING TYPE: OSFR ❑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) Z10ther:PV Solar Roof Mount installation <br /> DESCRIPTION OF WORK: <br /> PV Solar Roof Mount installation, 4 circuits, system size: 17.28kW, MPU <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 /> City of Everett Official Use Only <br /> PERMIT# <br /> C�QG�Q.Y <br /> 2/21/22 <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) <br />