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PERMIT APPLICATION <br /> /111P/A%/-7-41 <br /> BUILDINGECHANICAL/ PLUMBING / SIGN / iINKLER i DEMOLITION <br /> ./ CITY OF EVERETT PERMIT SERVICES <br /> �� 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:1708'Wetmore Ave Everett; WA 98201 PROPERTY TAX#: 00438034702900 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: SUSarlri ' ,;:.a TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Vetmore Ave <br /> citySTATE WA ziP 98201 <br /> OWNER PHONE: MIMIll <br /> OWNER EMAIL: FlylrTrtl�/Wlrle@msn.004T1 <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET 11.11111111111111111111 <br /> cTv Ev41111.. STATE WA zi, A R 7 n 1 <br /> CONTRACTOR PHONE: 425-330-4322 4141,-11 CONTRACTOR EMAIL: Cole(c bIossomsolar.COi'1'l <br /> CONTRACTOR LICENSE#(REQUIRED): BLOSSSL` 3M7 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 57621 <br /> PRIMARY CONTACT: ❑ OWNER rj CONTRACTOR 0 OTHER (Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-330-4322 <br /> Cole Anderson CONTACT EMAIL: Cole@biossomsolar.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ®SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑Need ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 5.49 kW grid tied solar system <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn Alteration Repair Type of Project: New _Addn Alteration Repair <br /> #of #of #of List of Fixtures List of Fixtures List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> _ <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER / SUPPRESSION SYSTEM <br /> Chemical or Water I No. of Heads <br /> 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 <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.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made. <br /> and/comply with the State Contractors Law 18.27 RCW and 296.200A WA C <br /> City of Everett Official Use Only <br /> ,i' ,/( / i ,ki / c7:41/---- Io��S la PERMI(�tJ\ q <br /> Owner/Authorized Agent Si( <br /> i nature Date/O (Revised 9/23/2016) <br />