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RETRI AL PERMIT L <br /> C C RMI A� KATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SiTEINFORMATION <br /> PROJECT ADDRESS: 1422 W. Mukilteo Blvd. Everett WA 98203 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: LI SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX ❑ MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> CTRICAL. • PPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 7,000.00 <br /> NUMBER OF DEVICES(if low voltate): <br /> FIRE ALARM? 0 YES 0 • <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 9.62 kW grid tied solar system <br /> CONTACT INFORMATION T' <br /> OWNER NAME: Erick Olson TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1422 W Mukilteo Blvd <br /> crry Everett STATE WA ZIP 98203 <br /> OWNER PHONE: (425)7504111 OWNER EMAIL: ottoolson@me.Com <br /> CONTRACTOR NAME: Blossom Solar LLC <br /> CONTRACTOR ADDRESS: STREET 1706 Lombard Ave <br /> CITY Everett STATE WA ZIP 98201 <br /> CONTRACTOR PHONE: 425-330-4322 CONTRACTOR EMAIL: tole@blossomsolar.com <br /> CONTRACTOR LIC.#(REQUIRED): BLOSSSL823M7 CITY OF EVERETT BUSINESS LIC.#(REQUIR ): 57621 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4254304322 <br /> Cole Anderson CONTACT EMAIL: Cole@blossomsolar.com <br /> AGREEMENT_f hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type <br /> of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this properly to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> (AJ (/ )(0 E --Out 9— <br /> Owner/Authorized Agent gnature Date (Revised 9123/2016) <br /> Ai <br /> 2 <br />