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Blip..DING PERMIT APPLICAMPN 9 ECEOV EVERETT CITY OF EVERETT PERMIT SERVICES SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and n r r of c pis rr irep,t revie , WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar S et 2nd F oo to p Bo . CONTACT INFORMATION: (P)425-257-8810 I (E)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION + OF EVEKt I I Crmit „e,v►c5 PROJECT SITE ADDRESS: STREET 1429 Broadway Ave PARCEL#: 00475428701500 CITY Everett STATE WA ZIP 98028 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME (if non-residential): Dr. Tae Youn and Dr Lewina Youn r•-•� Q -(, u'A f �il (19,At"I— ,' LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: ELS Specialties LLC OWNER MAILING ADDRESS: STREET 15808 Mill Creek Blvd, Suite 202 CITY Mill Creek STATE WA ZIP 98012 OWNER PHONE: 213-210-3137 OWNER EMAIL:tyounddsmd@gmail.com CONTRACTOR COMPANY NAME: Lunstrum Electric Inc WA STATE CONTRACTOR LICENSE#(REQUIRED): LUNSTEI882NH CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): #53442 CONTRACTOR ADDRESS: STREET 15372 Juanita Dr NE CITY Kenmore STATE WA ZIP 98028 CONTRACTOR PHONE: 206-930-0057 CONTRACTOR EMAIL: PETER@LUNSTRUMELECTRIC.COM PRIMARY CONTACT: ❑OWNER ®CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 206-930-0057 PETER LUNSTRUM CONTACT EMAIL: PETER@LUNSTRUMELECTRIC.COM BUILDING INFORMATION VALUATION OF WORK:$ 13,120 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: Dentist office PROPOSED USE OF BUILDING: Dentist office HEAT SOURCE: ❑Gas XElectric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ®Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ®Remodel ❑Repair DTI. ❑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: DESCRIPTION OF WORK: 24-400 watt solar panels installed on the roof, with a 12kwh battery backup system 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 I 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 fs, �� PERMIT# � �/ — o 8 3/20/23 /� Owner/Authorized Agent Signature Date (Revised 4/21/2022)