10121 25TH AVE SE 2024-08-02 - Laserfiche WebLink

BUILDING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS: See applicable submittal checklist 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)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET PARCEL#: 28052000206500 CITY Everett STATE WA zip 98208 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Russell Ryckman OWNER MAILING ADDRESS: STREET 0121 25th Ave SE CITY Everett STATE WA Zip 98208 OWNER PHONE: 425 293-5248 OWNER EMAIL: russellryckman@gmail.com CONTRACTOR COMPANY NAME:Lumio WA STATE CONTRACTOR LICENSE#(REQUIRED):LUM10H1789KR ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED):64332 CONTRACTOR ADDRESS: STREET 2500 Mottman Rd SW Suite 100 CITY Olympia STATE WA ZIP 98512 CONTRACTOR PHONE:360-777-6681 CONTRACTOR EMAIL:pnw.permltting@lurnio.COm PRIMARY CONTACT: ❑ OWNER V CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: Jesus Familia CONTACT PHONE:360-777-6681 CONTACT EMAIL:pnW.permitting@Iumio.Com BUILDING INFORMATION VALUATION OF WORK:$ 10,340 ASSOCIATED LAND USE PROJECT#(if applicable): (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:Residential PROPOSED USE OF BUILDING:No Change HEAT SOURCE: ❑Gas ❑Electric ❑Other BUILDING TYPE: VSFR ❑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 El Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) VOther:Rooftop Solar Installation DESCRIPTION OF WORK: 4.4OkWDC Rooftop Photovoltaic Solar Installation ACKNOWLEDGEMENT:1 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. 1 am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# 07/07/2023 ner/Authorized Agent Signature Date (Revised 2/8/2021)