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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 INFORMATION: (P) 425-257-8810 1 (E) PermitServices@everettwa.gov I (W) everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: STREET 2127 Oakes Avenue PARCEL #: 00439143801400 <br />cITY Everett STATE Washington Zlp 98201 <br />SUITE/UNIT #: FLOOR #: ADDITIONAL LOCATION INFORMATION (if applicable): <br />TENANT/BUSINESS NAME (if non-residential): <br />LEGAL DESCRIPTION for new construction: Short Plat/subdivision: 2127oakasAvanuaE-redWashington 98201 Lot No.: (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: Stephen Ehresman <br />OWNER MAILING ADDRESS: STREET 2127 Oakes Avenue <br />CITY Everett STATE ZIP 98201 <br />OWNER PHONE: (406) 672-6418 <br />OWNER EMAIL: steve.ehresman@gmall.Com <br />CONTRACTOR COMPANY NAME: Solgen Power, LLC <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): SOLGEPL820BE <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />CONTRACTOR ADDRESS: STREET 5715 Bedford Street <br />CITY Pasco STATE Washington ZIP 99301 <br />CONTRACTOR PHONE: 8557091 181 <br />CONTRACTOR EMAIL: permitting@solgenpower.com <br />PRIMARY CONTACT: ❑ OWNER 0 CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />Joan Calderon <br />CONTACT PHONE: 8557091 181 <br />CONTACT EMAIL:permitting@solgenpower.com <br />BUILDING INFORMATION <br />VALUATION OF WORK: $ 5,091.2 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 OF BUILDING: <br />HEAT SOURCE: ❑Gas ❑Electric ❑Other <br />BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />TYPE OF PROJECT (check all that apply) : ❑New Construction ❑Addition ❑Remodel [-]Repair ❑T.I. ❑Change of Use <br />❑Modular ❑Portable ❑Re -roof El Exterior Alteration ❑Tank (above ground) ❑Accessory Structure <br />❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank (above ground) ❑Other: PV Solar Roof mount installation <br />DESCRIPTION OF WORK: <br />PV Solar Roof mount installation, 5.92kW, 2 circuits <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 1 am authorized by the owner of this property to perform the work for which application is made, <br />and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />07/14/2022 <br />Agent Signature Date <br />City of Everett Official Use Only <br />PERMIT # <br />(Revised 412112022) <br />