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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 /> WASHI NOTON 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 J(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 10726 20th PI W PARCEL M <br /> CITY Everett STATE Washington ZIP 98204 <br /> SUITE/UNIT M FLOOR M ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANTIBUSINESS 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: Marvin Wuest <br /> OWNER MAILING ADDRESS: STREET 1072620th PI W <br /> CITY Everett STATE Washington zip 98204 <br /> OWNER PHONE: +14257911273 OWNER EMAIL: Mwwuest@hotmail.com <br /> CONTRACTOR COMPANY NAME: BRS Field Ops,LLC <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): BRSFIF0828M4 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 60040 <br /> CONTRACTOR ADDRESS: STREET 1403 N Research Way <br /> CITY Orem STATE UT ziP 84097 <br /> CONTRACTOR PHONE: 385482-0045 CONTRACTOR EMAIL: Permitting,department@blueravensolar.com <br /> PRIMARY CONTACT: ❑OWNER NTRACTOR HER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 385-482-0045 <br /> Diana Sanchez <br /> CONTACT EMAIL: permitting.department@blueravensolar.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ 6,062.78 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: <br /> PROPOSED USE ILDI <br /> HEAT SOURCE: s ctric er <br /> BUILDING TYPE: R wnhouse III U Family- its: cial cessory Structure <br /> T OF PR(�.t�rT(check at apply • w Construct' dition pair ange of Use <br /> dinar riable -roof rior Alteration nk(above ground) cessory Structure <br /> nce over 7ft high ckStorage of/Mot Tub nk(above ground) ec PV Solar Array <br /> DESCRIPTION OF WORK: <br /> INSTALLATION OF UTILITY INTERACTIVE PHOTOVOLTAIC SOLAR SYSTEM AND ANY NECESSARY ADDITIONAL WORK NEEDED <br /> FOR INSTALLATION <br /> ACKNOWLEDGEMENT:l 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./am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> V (�j Permit Coordinator 09112!2023 PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 412112022) <br />