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• • <br /> MN <br /> 111.111 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 l(E)PermitServices@everettwa.gov l(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION .. <br /> PROJECT SITE ADDRESS: STREET 10115 Holly Dr PARCEL#: <br /> ciTn Everett STATE WA zip 98204 <br /> SUITE/UNIT#: Building/(w FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential):Olin Fields Apartments <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> s : CONTACT INFORMATION <br /> OWNER NAME:OIin Fields Owner LLC <br /> OWNER MAILING ADDRESS: STREET 701 5th Ave , Suite 5700 <br /> ciTy Seattle STATE WA ZIP 98104 <br /> OWNER PHONE:509-833-6657 OWNER EMAIL: CodyJ@secprop.com <br /> CONTRACTOR COMPANY NAME:Keck General Construction <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):CCKECKGGC855RW CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): -veege . <br /> CONTRACTOR ADDRESS: STREET17311 135th Ave NE Suite B400 <br /> c,Ty Woodinville STATE WA zip 98072 <br /> CONTRACTOR PHONE:425-231-7004 CONTRACTOR EMAIL:Shane@keckgc.COm <br /> PRIMARY CONTACT: 0 OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-731-7004 <br /> _ <br /> Shane Keck CONTACTEMAIL:shane@keckgc.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: 2'97$4G'1. 61 71 d,6 D ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair market value f all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING:MUtl Family Housing <br /> PROPOSED USE OF BUiLDING:Multi Family Housing <br /> HEAT SOURCE: EGas CElectric ❑Other <br /> BUILDING TYPE: ESFR ❑Townhouse ❑Duplex ❑ADU ❑✓Multi-Family-#Units:352 OCommercial EAccessory Structure <br /> TYPE OF PROJECT(check all that apply): ['New Construction ❑Addition ❑Remodel ❑Repair CIT.!. ❑Change of Use <br /> EModular ❑Portable nRe-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK:remove and replace roof shingles with like and kind material <br /> ACKNOWLEDGEMENT:l 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 I 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 /> PERMIT# Bo... .07......, <br /> ®g <br /> Shane-!Ce-c(c 7/25/22 <br /> Owner/Authorized Agent Signature Date (Revised 4/21/2022) <br /> �- <br />