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• <br /> E BUILDING PERMIT APPLICATI <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 l(E)PermitServlces@everettwa.gov l(W)everettwa.gov/permits <br /> Blue or Black Ink Only Please) <br /> PROJECT SITE ADDRESS: STREET 10115 Holly Dr. PARCEL#• 28042400201100 <br /> ii <br /> c1Ty Everett STATE WA ZIP 98204 <br /> SUiTE/UNIT#: Building V 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 /> . CON.T AOT:INFORMATION .. . . ...,....,......:....::., :..::.....:: <br /> OWNER NAME:Olin Fields Owner LLC <br /> OWNER MAILING ADDRESS: STREET 701 5th Ave, Suite 5700 <br /> cnr 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 ff(REQUiRED): 64875 <br /> CONTRACTOR ADDRESS: STREET17311 135th Ave NE Suite B400 <br /> cliv Woodinville STATE WA zip 98072 <br /> CONTRACTOR PHONE:425-231-7004 CONTRACTOR EMAIL:shane@keckgc.com <br /> PRIMARY CONTACT: ❑OWNER D✓ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-498-2332 <br /> Jason Bean CONTACT EMAIL:jason@keckgc.com <br /> BUILDIN <br /> GBUILDING INFO ... <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 /> HEAT SOURCE: ❑Gas ❑✓Electric DOther <br /> BUILDING TYPE: ❑SFR DTownhouse ❑Duplex ❑ADU DMA-Family-#Units:352 OCommercial ❑Accessary Structure <br /> TYPE OF PROJECT(check all that apply): ONew Construction DAddition DRemodel ❑✓Repair DT.I. OChange of Use <br /> OModular ❑Portable ORe-roof ❑Exterior Alteration OTank(above ground) DAccessory Structure <br /> ❑Fence over 7ft high DRackStorage OPool/Hot Tub ❑Tank(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: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 /> Jason, 130o4 11/18/2022 PERMIT# <br /> 0 3 <br /> Owner/Authorized Agent Signature Date (Revised 4/21/2022) <br />