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• <br /> NEN <br /> BUILDING PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 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 I(E)PermitServices@everettwa.gov l(W)everettwa.gov/permits <br /> (Blue.or Blank Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 10115 Holly Dr. PARCEL#: 28042400201100 <br /> GIN Everett STATE WA ZIP 98204 <br /> SUITE/UNIT#: Budding A 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 /> ::::::.:;::::::: CONTACT.:INFORMATION . • <br /> OWNER NAME:OIin Fields Owner LLC <br /> OWNER MAILING ADDRESS: STREET 701 5th Ave, Suite 5700 <br /> cdTY Seattle STATE WA zip 98104 <br /> OWNER PHONE:509-833-6657 OWNER EMAIL: CodyJ@secprop,com <br /> CONTRACTOR COMPANY NAME:KOCk General Construction <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):CCKECKGGC855RW CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 64875 <br /> CONTRACTOR ADDRESS: sTREETI7311 135th Ave NE Suite B400 <br /> CITY Woodinville STATE WA ZIP 98072 <br /> CONTRACTOR PHONE:426-231-7004 CONTRACTOR EMAIL:shane@keckgc.com <br /> PRIMARY CONTACT: ❑OWNER El CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-498-2332 <br /> Jason Bean CONTACT EMAIL:jason©keckgc.corn <br /> .....:.....:................... . ... .. . ... .... ..... <br /> INFORMATION ::::::•::':`;::;::.:.:;::; <br /> VALUATION OF WORK:$$40,000 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:Multi-Family <br /> PROPOSED USE OF BUILDING:Multi-Family <br /> Jr <br /> HEAT SOURCE: OGas ❑✓Electric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU i]MuIti-Family-#Units:352 ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ONew Construction ❑Addition ❑Remodel ERepair ❑T.I. ❑Change of Use <br /> ❑Modular ❑Portable ORe-roof ❑F.xteriorAlteration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub Drank(above ground) ❑Other <br /> DESCRIPTION OF WORK:Exterior deck repair. Demolition of damaged wood and repair of wood with like and <br /> kind materials according to plans. Application of waterproofing detail according to <br /> plans. <br /> ACKNOWLEDGEMENT::!have reviewed this application and confirm the information contained herein Is true and correct.Work dons 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.1 am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and!comply with the State Contractors Law 18,27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 11/18/2022 D�� <br /> Owner/Authorized Agent Signature Date {Revised 4/21/2022) <br />