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DocuSign Envelope ID: 1452ACBB-8281-421F-BD22-A5DA8F3A1A6E <br /> 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 2006 Highland Ave PARCEL#: 00563241001900 <br /> CITY Everett STATE WA zlp 98201 <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: Stephanie Hardgrave <br /> OWNER MAILING ADDRESS: STREET 2006 Highland Ave <br /> CITY Everett STATE WA ZIP 98201 <br /> OWNER PHONE: (206) 380-5384 OWNER EMAIL: stephanie.hardgrave@gmail .com <br /> CONTRACTOR COMPANY NAME: Solgen Power LLC <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): SOLGEPL830R3 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 62231 <br /> CONTRACTOR ADDRESS: STREET 6752 20th St E STE 200 <br /> CITY Fife STATE WA ZIP 98424 <br /> CONTRACTOR PHONE: (206) 649-9976 CONTRACTOR EMAIL: picseattle@purelightpower.com <br /> PRIMARY CONTACT: ❑OWNER ®CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: Bryann Pl uta CONTACT PHONE: (206) 649-9976 <br /> CONTACT EMAIL: picseattle@purelightpower.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $ 30381.00 ASSOCIATED LAND USE PROJECT#(if applicable): <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: Single Family Dwelling <br /> PROPOSED USE OF BUILDING: Solar Installation <br /> HEAT SOURCE: [-]Gas ❑Electric R]Other N/A <br /> BUILDING TYPE: RISFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction UAddition [-]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) K]Other: Sol ar PV <br /> DESCRIPTION OF WORK: 7,790kWDC 6.797kWAC roof mounted solar install on existing home, 1 circuit <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 /> j <br /> DocuSigned by: <br /> PERMIT# <br /> y aWA, �� O, 2/16/2024 1 3:48:32 PM PST <br /> Owner/Authorize n� ign u e Date (Revised 2/8/2021) <br />