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BUILDING PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review, WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION: (P) 425-257-8810 1 (E) PermitServices@everettwa gov I (W) everettwa / t gov perm) s (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 9 S 20 1$ Are. VJ PARCEL #: 00480600102000, 00480600102104 EVERETT CITY STATE WA ZIP 98204 SUITE/UNIT #: A - C FLOOR #: 1-3 ADDITIONAL LOCATION INFORMATION (if applicable): Building D TENANT/BUSINESS NAME (if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Benton Square Lot No.: 18 - 20 (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: PACIFIC RIDGE - DRH, LLC OWNER MAILING ADDRESS: STREET 17921 BOTHELL EVERETT HWY, SUITE 100 CITY BOTHELL STATE WA ZIP 98012 OWNER PHONE: (425) 439-1164 OWNER EMAIL: RLClancy@drhorton.com CONTRACTOR COMPANY NAME: PACIFIC RIDGE - DRH, LLC WA STATE CONTRACTOR LICENSE #(REQUIRED): PACI FRD851 JB /_ CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): S l 'f 03 CONTRACTOR ADDRESS: STREET17921 BOTHELL EVERETT HWY, SUITE 100 CITY BOTHELL STATE WA ZIP 93012 CONTRACTOR PHONE:425.939.1164 CONTRACTOR EMAIL: RLClancy@drhorton.com & JWAtkin@drhorton.com PRIMARY CONTACT: ID OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: Rhonda Clancy and/or Jason Atkin CONTACT PHONE:425.939.1164 CONTACT EMAIL: RLClancy@drhorton.com & JWAtkin@drhorton.com BUILDING INFORMATION VALUATION OF WORK: $ 887,612.34 3 s 295,; ! u • 1 g ASSOCIATED LAND USE PROJECT # (if applicable): (Valuation shall include the prevailing fair market falue of all labor, materials, and equipment needed to complete the work, whether actually paid or not.) EXISTING USE OF BUILDING: N/A ' PROPOSED USE OF BUILDING: MULTI -FAMILY RESIDENTIAL HEAT SOURCE: ❑Gas ✓❑Electric []Other BUILDING TYPE: ❑SFR WITownhouse ❑Duplex ❑ADU ✓❑Multi -Family -# Units: 1 - 3 ❑Commercial ❑Accessory Structure TYPE OF PROJECT (check all that apply) :❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable []Re -roof ❑Exterior Alteration ❑Tank (above ground) ❑Accessory Structure []Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank (above ground) ❑Other: DESCRIPTION OF WORK: New construction of 3 story 3 unit townhome, part of a 5 building community b ul l d'I nn D � 7 Z b 1 S'h Ave, V.) ACKNOWLEDGEMENT: 1 have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with 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 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, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. onzed Agent Slgnatu 08.11.23 Date City of Everett Official Use Only PERMIT# (Revised 412112022) lJ