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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 3702 Rockefeller Ave PARCEL#: 00438188201100 <br /> CITY EVERETT STATE Washington ZIP 98201 <br /> Sul E/UNIT M 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: Kay Hollenbeck <br /> OWNER MAILING ADDRESS: STREET 3702 Rockefeller Ave <br /> CITY EVERETT STATE Washington zip 98201 <br /> OWNER PHONE: '12063846972 OWNER EMAIL: kayjae2626@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 FNTRACTOR 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: $ 6,058.27 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: R wnhouse lex U '-Family its: cial cessory Structure <br /> T OF PRC�.I�rT(check at apply, w Construct' dition pair ange of Use <br /> dular Urtable -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 /> SYSTEM TO BE INSTALLED INFORMATION: <br /> DC SYSTEM SIZE: 6.715 kW DC <br /> AC SYSTEM SIZE:4.93 kW AC <br /> MODULE TYPE: (17)QCells Q.PEAK DUO BLK ML-G10+ 395 <br /> INVERTER TYPE: Enphase IQ8PLUS-72-2-US <br /> MONITORING: Enphase IQ Combiner 4 X-IQ-AM1-240-4 <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 /> City of Everett Official Use Only <br /> (� <br /> n _nou (n _&()V� PERMIT# <br /> � Permit Coordinator 04/04/2023 <br /> Owner/Authorized Agent Signature Date (Revised 412112022) <br />