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BLD2025-0097_Application_1.22.2025_12.38.29_PM_4723291CITY OF EDMONDS MyBuildingPermit.com Electrical Application #1604087 - 13113 - Derry PV Applicant First Name Last Name Company Name Jacob Benzaquen Northwest Electric and Solar Number Street Apartment or Suite Number E-mail Address 18001 73rd Ave NE jacobb@nwsolar.com City State Zip Phone Number Extension Kenmore WA 98028 (715) 297-4419 Contractor Company Name NORTHWEST ELECTRIC & SOLAR LLC Number Street Apartment or Suite Number 18001 73rd Ave NE City State Zip Phone Number Extension Kenmore WA 98028 (206) 356-0601 State License Number License Expiration Date UBI # E-mail Address NORTHES876MA 7/2/2025 F;nii 4f1R5g jacobb@nwsolar.com Project Location Number Street Floor Number Suite or Room Number 16107 74TH PL W City Zip Code County Parcel Number EDMONDS 98026 00790400001000 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 E Derry Number Street Apartment or Suite Number 16107 74TH PL W City State Zip EDMONDS WA 98026 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: 1/22/2025 Submitted By: Jacob Benzaquen Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Electrical Application #1604087 - 13113 - Derry PV Project Contact Company Name: Northwest Electric and Solar Name: Jacob Benzaquen Email: jacobb@nwsolar.com Address: 18001 73rd Ave NE Phone #: (715) 297-4419 Kenmore WA 98028 Project Type Single Family Residential Activity Type Scope of Work Alteration Photo -Voltaic Project Name: 13113 - Derry PV Description of Work: 9.46kW PV Array 22 x Silfab 430 QD Prime NTC mods PW3 Integrated inverter (ESS under different permit) Project Details Alternate Power Source Solar Photovoltaic System 1 Work Location Work Description/Location (example: 1 st floor, Roof/Exterior Wall Master Bath, Garage) Page 2 of 2