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BUILDING PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETTSUBMITTAL 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 I NFORMATION: (P) 425-257-88101 (E) PermitServices@everettwa.gov I (W) everetwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: STREET 2801 Baker Ave PARCEL #: 00437865800100 <br />CITY EVERETT STATE Washington ZIP 98201 <br />SUITEIUNIT #: 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 />OWNERNAME: Dave Morck <br />OWNER MAILING ADDRESS: STREET 2801 Baker Ave <br />CITY EVERETT STATE Washington zip 98201 <br />OWNER PHONE: +14252811262 <br />OWNER EMAIL: davemorck@live.com <br />CONTRACTOR COMPANY NAME: BRS Field Ops, LLC <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): BRSFIFO828M4 <br />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: 385-482-0045 CONTRACTOR EMAIL: Permitting.department@blueravensolar.com <br />PRIMARY CONTACT: ❑ OWNER NTRACTOR HER (Please Specify) <br />CONTACT NAME: <br />Carson Campbell <br />CONTACT PHONE: 385-482-0045 <br />CONTACT EMAIL: pe"itting.department@blueravensolar.com <br />BUILDING INFORMATION <br />VALUATION OF WORK: $ 6,771.01 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: is ctric er <br />BUILDING TYPE: R wnhouse lex U -Family - its I U cial cessory Structure <br />T OF Pi (check at apply, � w ConstrPkdition pair ange of Use <br />dular Piroof rior Alterationnk (above ground) cessory Structure <br />nce over 7ft high ckstorage of/Hot Tub (above ground) er: PV Solar Array <br />DESCRIPTION OF WORK: <br />SCOPE OF WORK <br />INSTALLATION OF UTILITY INTERACTIVE PHOTOVOLTAIC SOLAR SYSTEM AND ANY <br />NECESSARY ADDITIONAL WORK NEEDED FOR INSTALLATION. <br />ACKNOWLEDGEMENT/ 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. 1 am the owner, or 1 am authorized by the owner of this property to perform the work for which application is made, <br />and 1 comply with the State Contractors Law 18.27 R C W and 296.200A WAC. <br />City of Everett Official Use Only <br />(� <br />^ (ou �^" (n �(arp(I�CG Permit Coordinator 01 / 19 / 2023 Pi <br />ier/Authorized Agent Signature Date (Revised 4/212022) <br />