BLD2022-1318_Application_9.30.2022_12.28.15_PM_3138871CITY OF EDMONDS MyBuildingPermit.com
Electrical Application #1209668 - Davis Solar Project
Applicant
First Name Last Name Company Name
Nicholas Anderson Blossom Solar LLC
Number Street Apartment or Suite Number E-mail Address
1706 Lombard Ave office@blossomsolar.com
City State Zip Phone Number Extension
Everett WA 98201 (425) 610-7067
Contractor
Company Name
BLOSSOM SOLAR LLC
Number Street Apartment or Suite Number
1706 Lombard Ave
City State Zip Phone Number Extension
Everett WA 98201 425-610-7067
State License Number License Expiration Date UBI # E-mail Address
BLOSSSL823M7 7/27/2024 FD4D7gRR7 office@blossomsolar.com
Project Location
Number Street Floor Number Suite or Room Number
22519 95TH PL W
City Zip Code County Parcel Number
EDMONDS 98020 00544300007100
Associated Building Permit Number Tenant Name
Additional Information (i.e. equipment location or special instructions)_
Work Location
Property Owner
First Name Last Name or Company Name
William L\mary Davis
Number Street Apartment or Suite Number
22519 95TH PL W
City State Zip
EDMONDS WA 98020
Certification Statement - The applicant states:
I certify that I am the owner of this property or the owner's authorized agent. If acting as an authorized agent, I further certify that I have full power and
authority to file this application and to perform, on behalf of the owner, all acts required to enable the jurisdiction to process and review such application. I
have furnished true and correct information. I will comply with all provisions of law and ordinance governing this type of application. If the scope of work
requires a licensed contractor to perform the work, the information will be provided prior to permit issuance.
Date Submitted: 9/30/2022 Submitted By: Nicholas Anderson
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CITY OF EDMONDS MyBuildingPermit.com
Electrical Application #1209668 - Davis Solar Project
Project Contact
Company Name: Blossom Solar LLC
Name: Nicholas Anderson Email: office@blossomsolar.com
Address: 1706 Lombard Ave Phone #: (425) 610-7067
Everett WA 98201
Project Type Activity Type Scope of Work
Single Family Residential Alteration Photo -Voltaic
Project Name: Davis Solar Project
Description of Work: 5.18 kW grid tied roof mounted solar system
Project Details
Alternate Power Source
Solar Photovoltaic System 1
Work Location
Work Description/Location (example: 1st floor, Rooftop
Master Bath, Garage)
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