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BUILDING PERMIT APPLICAI ON <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 `l R 20 IV*?r4-C W PARCEL M 00-0600102000,0.8M00102104 <br /> CITY EVERETT WA <br /> STATE ZIP 98204 <br /> SUITE/UNIT#: A-C FLOOR#: 1 -3 ADDITIONAL LOCATION INFORMATION (if applicable): Building D <br /> TENANT/BUSINESS NAME(if non-residential): <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Benton Square Lot No.: 18-20 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:PACIFIC RIDGE - DRH, LLC <br /> OWNER MAILING ADDRESS: STREET 17921 BOTHELL EVERETT HWY,SUITE 100 <br /> BOTHELL <br /> CITY STATE WA ZIP 98012 <br /> OWNER PHONE:(425)439-1 164 OWNER EMAIL: RLClancy@drhorton.COm <br /> CONTRACTOR COMPANY NAME:PACIFIC RIDGE - DRH, LLC <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):PACIFRD851 JB CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 'D(O'f O3 <br /> CONTRACTOR ADDRESS: STREET 17921 BOTHELL EVERETT HWY, SUITE 100 <br /> CITY BOTHELL STATE WA z.P 98012 <br /> CONTRACTOR PHONE:425.939.1164 CONTRACTOR EMAIL:RLClancy@drhorton.com &JWAtkin@drhorton.com <br /> PRIMARY CONTACT: I]OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425.939.1164 <br /> Rhonda Clancy and/or Jason Atkin CONTACT EMAIL:RLClancy@drhorton.com &JWAtkin@drhorton.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $887,612.34 3= -7$ ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair market alueaf'all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING:N/A <br /> PROPOSED USE OF BUILDING:MULTI-FAMILY RESIDENTIAL <br /> HEAT SOURCE: ❑Gas ZElectric ❑Other <br /> BUILDING TYPE: ❑SFR (✓(]Townhouse ❑Duplex ❑ADU ❑✓Multi-Family-#Units:1-3 ❑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 El Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK: <br /> New construction of 3 story 3 unit townhome, part of a 5 building community <br /> l Ck' n� <br /> Ave tl\) fi <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 l 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 /> 08.11 .23 _ <br /> iJ��J✓�, `; I <br /> Owner/Authorized Agent Signatur Date (Revised 412112022) <br />