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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: 707 93rd St SE BUILDING AREA: 1 760 sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION 0 ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: 0 SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK: $ 6,804 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> PV Solar Roof Mount Installation, 2 Circuits, 5.67kWDC <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑ NO ❑ YES-Select Scope: ❑ Service ❑ Feeder s❑ Circuits-#: ❑ Complete Re-wire <br /> LOW VOLTAGE WORK? 0 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 /> 0 other(List All):PV solar roof mount installation <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 296-4613-900,selected the specific reason on page 2 <br /> El 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: ONO [_ -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: Jeanne Barrans TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 707 93rd St SE <br /> CITY Everett STATE WA ZIP 98208 <br /> OWNER PHONE:(425) 327-8143 OWNER EMAIL:Jeanne.barrans@gmall.com <br /> CONTRACTOR NAME: Sogen Power, LLC <br /> CONTRACTOR ADDRESS: STREET5715 Bedford St <br /> CITY Pasco STATE WA ZIP 99301 <br /> CONTRACTOR PHONE:(509) 316-0364 CONTRACTOR EMAIL:permitting@solgenpower.com <br /> CONTRACTOR LIC.#(REQUIRED):SOLGEPL830RJ 7CITY OF EVERETT BUSINESS LIC.#(REQUIRED):62231 <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:(509) 394-4099 <br /> Feb Rhea Develos CONTACT EMAIL:permitting@solgenpower.com <br /> AGREEMENT.1 hereby certify that/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/am authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> 11/8/2023 E <br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />