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BUILDING PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT <br />SUBMITTAL 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 I (E) everetteps@everettwa.gov I (W) everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: STREET 2408 Oakes Avenue PARCEL #: 00439155002800 <br />CITY Everett STATE WA zip 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: Lot No.: (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: Karen Smith <br />OWNER MAILING ADDRESS: STREET 2408 Oakes Avenue <br />CITY Everett STATE WA ziP 98201 <br />OWNER PHONE: 425 923-3541 <br />OWNER EMAIL: zandertami@hotmail.com <br />CONTRACTOR COMPANY NAME: Lumio <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): LUMIOHI789KR <br />ICITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 64332 <br />CONTRACTOR ADDRESS: STREET 2500 Mottman Rd SW Suite 100 <br />CITY Olympia STATE WA zip 98512 <br />CONTRACTOR PHONE: 360-777-6681 <br />CONTRACTOR EMAIL: pnw.permltting@lumio.Com <br />PRIMARY CONTACT: ❑ OWNER V CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: Jesus Familia <br />CONTACT PHONE: 360-777-6681 <br />CONTACT EMAIL: pnW.permitting@Iumio.com <br />BUILDING INFORMATION <br />VALUATION OF WORK: $ $ 460 <br />1ASSOCIATED 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: Residential <br />PROPOSED USE OF BUILDING: No Change <br />HEAT SOURCE: ❑Gas ❑Electric ❑Other <br />BUILDING TYPE: VSFR ❑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 El -rank (above ground) VOther: Rooftop Solar Installation <br />DESCRIPTION OF WORK: <br />3.60kWDC Rooftop Photovoltaic Solar Installation <br />Main Service Panel Upgrade <br />ACKNOWLEDGEMENT: 1 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 RCW and 296.200A WAC. <br />Agent Signature Date <br />City of Everett Official Use Only <br />PERMIT # <br />(Revised 21812021) <br />