11103 3RD PL SE 2025-03-24 - 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 11103 3rd PI SE PARCEL#: 00574600000900 CITY Everett STATE WA ZIP 98208 Sul E/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: Dave Ferguson OWNER MAILING ADDRESS: STREET 11103 3rd PI SE CITY Everett STATE WA ZIP 98208 OWNER PHONE: 425-737-6853 OWNER EMAIL: df5557@gmail.com CONTRACTOR COMPANY NAME: Solgen Power LLC WA STATE CONTRACTOR LICENSE#(REQUIRED): SOLGEPL830RJ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 62231 CONTRACTOR ADDRESS: STREET 6752 20th St E STE 200 CITY Fife STATE WA ZIP 98424 CONTRACTOR PHONE: (206)649-9976 CONTRACTOR EMAIL: picseattle@purelightpower.com PRIMARY CONTACT: ❑OWNER FI CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: Joseph Kwon CONTACT PHONE: (206)649-9976 CONTACT EMAIL: picseattle@purelightpower.com BUILDING INFORMATION VALUATION OF WORK: $ 29,274.00 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: Single Family Dwelling PROPOSED USE OF BUILDING: Solar Installation HEAT SOURCE: [-]Gas ERlectric ❑Other N/A BUILDING TYPE:®SFR ❑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 ❑Exterior Alteration [-]Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) Other: Solar PV DESCRIPTION OF WORK: 6.970kWDC roof mounted solar install on existing home 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 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.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only t7a�v/ k PERMIT# (�( 09/19/2024 Owner/Authorized Agent Signature Date (Revised 21812021) Document Ref:MEQMJ-LU6QH-ZV2NP-KSZUW Page 1 of 1