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ELECTRICAL PERMIT APPLICATION <br /> EVERETT 32CITY OF EVERETT PERMIT SERVICES <br /> 00 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 5809 East Dr, Everett, WA 98203 IBUILDING AREA: sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL Install Cell Kit Type:"Plug and Play" <br /> BUILDING USE: ❑SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK: $ 0 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> Cell Modem Install for Micro-inverters. It is a Cell Kit Installer will plug in the USB to Micro-USB cord <br /> to the Combiner Box to allow the Solar System to read and report all Micro-inverters to customer's System <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑✓ NO ❑YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire <br /> LOW VOLTAGE WORK? ❑✓ NO ❑YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑ Audio ❑ Secure Access ❑ Security System <br /> ❑ Fire Alarm- Installations under this permit only include electrical wiring rough-in of the system.An additional <br /> Fire Alarm Permit is required for review of device location and installation approval. <br /> ❑✓ Other(List All): Replacing Failed Micro-Inverter on solar system <br /> CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ✓ NO YES--See Below&Pg. 2 <br /> By checking this box, I am stating that I have read and understand all of WAC 296-46B-900,selected the specific reason on page 2 <br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not <br /> See Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ❑✓ NO ❑YES-See Below&Pg.3 <br /> ❑ Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease <br /> without the proper electrical licensing and certification, or exemption. By checking this box, I am stating that I have completed and <br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> CONTACT INFORMATION <br /> OWNER NAME: Colleen Hernandez TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5809 East Dr <br /> ,IT, Everett STATE WA 1, 98203 <br /> OWNER PHONE:(425) 308-9625 OWNER EMAIL:chernandez1973@msn.com <br /> CONTRACTOR NAME: Nationwide Solar, Fabian Angobung, Permit Technician <br /> CONTRACTOR ADDRESS: STREET PO BOX 821959 <br /> CITY Vancouver STATE WA ZIP 98682 <br /> CONTRACTOR PHONE:800-908-8992 CONTRACTOR EMAIL:permitdept@mynationwidesolar.com <br /> CONTRACTOR LIC.#(REQUIRED):NAITOS*786TW CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 64489 <br /> PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:800 908 8992 <br /> Fabian Angobung, PT CONTACT EMAIL:permitdept@mynationwidesolar.com <br /> AGREEMENT-/hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br /> 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 <br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> 1/4/2024 JE <br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />