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B' "WING PERMIT APPLICAT 7N <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <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 1(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 9502 18th Ave W Unit M PARCEL#: 0048060010090 <br /> clTy Everett STATE WA Zip 98201 <br /> SUITE/UNIT#: Lot 13 FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): Harrison Pointe <br /> TENANT/BUSINESS NAME(if non-residential):Harrison Pointe Lot 13 <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Harrison Pointe Lot No.: 13 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Pacific Ridge Homes- DR Horton LLC <br /> OWNER MAILING ADDRESS: STREET 17921 Bothell Everett Hwy Ste 100 <br /> clTy Bothell <br /> STATE WA ZIP 98012 <br /> OWNER PHONE:425.939.1164 OWNER EMAIL: RLClancy@drhorton.com <br /> CONTRACTOR COMPANY NAME:Pacific Ridge Homes-DR Horton LLC <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):PACIFRD851 JB CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET 17921 Bothell Everett Hwy Ste 100 <br /> CITY Bothell STATE WA ZIp 98012 <br /> CONTRACTOR PHONE:425.939.1164 CONTRACTOR EMAIL:RLClancy@drhorton.com <br /> PRIMARY CONTACT: 17 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425.939.1164 <br /> Rhonda Clancy CONTACT EMAIL:RLClancy@drhorton.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$35 0.00 3C `A S ASSOCIATED LAND USE PROJECT#(if applicable):revii22-008 & revii22-007 <br /> (Valuation shall include the prevailin air market value of all laboL)Lnaterials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING:N/A <br /> PROPOSED USE OF BUILDING:New Single Family Home <br /> HEAT SOURCE: ❑Gas ZElectric []Other <br /> BUILDING TYPE: ✓❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ✓❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) []Accessory Structure <br /> ❑Fence over 7ft high ❑Rackstorage ❑Pool/Hot Tub ❑Tank(above ground) ❑✓Other:RB2306-005 Lennon AB <br /> DESCRIPTION OF WORK: <br /> New single family home using Registered Basic RB2306-005 <br /> D [Ef-Zk <br /> En� n2� <br /> L= <br /> OCT 0 5 2023 <br /> C <br /> ACKNOWLEDGEMENT/have reviewed this application and confirm the information contained herein is true and correct. Work{ao807il'taSQktyj9AA must comply with <br /> current federal,state, and local law. The granting of a penrit 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.l am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 10.02.23 PnIT# <br /> -02-9 <br /> Owner/Authorized Agent Signatu Date (Revised 4/21/2022) <br />