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BPLDING PERMIT APPLICATI. <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 I(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 10115 Holly Dr PARCEL#: 28042400201100 <br /> CITY Everett STATE WA ZIP 98204 <br /> SUITE/UNIT#: Building R FLOOR#:2 ADDITIONAL LOCATION INFORMATION (if applicable):Breezeway <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:Olin Fields 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): 64875 <br /> CONTRACTOR ADDRESS: STREET 1731 1 135th Ave NE Suite B400 <br /> CITY Woodinville STATE WA ZIP 98072 <br /> CONTRACTOR PHONE:425-231-7004 CONTRACTOR EMAIL:shane@keCkgC.COm <br /> PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-498-2332 <br /> Jason Bean CONTACT EMAIL:jason@keckgc.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $67,000 .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:MUltl Family Housing <br /> PROPOSED USE OF BUILDING:MUlti Family Housing <br /> HEAT SOURCE: El Gas ❑✓Electric El Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ADU ❑✓Multi-Family-#Units:352 ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction Addition El Remodel ✓❑Repair ❑T.I. Change of Use <br /> El Modular ❑Portable ❑Re-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:Demolition and repair/rebuild of existing exterior breezeway. <br /> *life and safety issues due to rotted wood. Rotted wood found during cosmetic wood <br /> repairs. <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 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# <br /> Owner/A, thorized Agent Signature Date (Revised 4/21/2022) <br /> C/ �/ <br />