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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 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 7502 7th Dr W PARCEL#: 00708000000500 <br /> CITY Everett STATE Washington ZIP 98203 <br /> SUITEIUNIT#: FLOOR M 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: David Taft-Farren <br /> OWNER MAILING ADDRESS: STREET 7502 7th Dr W <br /> cnY Everett STATE Washington zip 98203 <br /> OWNER PHONE: 4254181775 OWNER EMAIL: dtaftfarren@gmail.com <br /> CONTRACTOR COMPANY NAME: BRS Field Ops,LLC <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): BRSFIF0828M4 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 60040 <br /> CONTRACTOR ADDRESS: STREET 1403 N Research Way <br /> CITY Orem STATE UT zip 84097 <br /> CONTRACTOR PHONE: 385-482-0045 CONTRACTOR EMAIL: permitting.department@blueravensolar.com <br /> PRIMARY CONTACT, ❑OWNER � NTRACTOR HER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 385-482-0045 <br /> Carson Campbell <br /> CONTACT EMAIL: permitting.department@blueravensolar.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ 3,410.32 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 ILDI <br /> HEAT SOURCE: S ctric er <br /> BUILDING TYPE: V R wnhouse lex U '-Family- its: cial cessory Structure <br /> TYPE OF PRQJECT(check at apply, w Construct dition pair ange of Use <br /> dular rtabie -roof rior Alteration nk(above ground) cessory Structure <br /> nce over 7ft high ckStorage of/Hot Tub nk(above ground) er: PV Solar Array <br /> DESCRIPTION OF WORK: <br /> 3.78 kW PV Solar Panel Installation on Roof <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 Oficial before being authorized under any circumstance.1 am the owner,or I 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 /> City of Everett Official Use Only <br /> Caam (�((n_&(Ivh& PERMIT# ,l <br /> Permit Coordinator 09/15/2023 VJ� — Co <br /> Owner/Authorized Agent Signature Date (Revised 4/21/2022) <br />