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BUILDING PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETTSUBMITTAL 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 002F 1$2,0 19 tfi Ale W PARCEL#: 00480600102000,00480600102104 <br /> CITY EVERETT STATE WA 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 /> cry BOTHELL STATE WA ZIP 98012 <br /> OWNER PHONE:(425)439-1164 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): 5 03 <br /> CONTRACTOR ADDRESS: STREET 17921 BOTHELL EVERETT HWY, SUITE 100 <br /> Crry BOTHELL STATE WA ZP 98012 <br /> CONTRACTOR PHONE:425.939.1164 CONTRACTOR EMAIL:RLClancy@drhorton.com&JWAtkin@drhorton.com <br /> PRIMARY CONTACT: 0 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 /> BU LDING INFORMATION <br /> VALUATION OF WORK:$887, 2.34 3= 29 •7 8 JASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair market talue o abor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING:N/A <br /> PROPOSED USE OF BUILDING:MULTI-FAMILY RESIDENTIAL <br /> HEAT SOURCE: ❑Gas DElectric ❑Other <br /> BUILDING TYPE: ❑SFR (]Townhouse ❑Duplex ❑ADU ❑✓Multi-Family-#Units:1-3 ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ONew Construction ❑Addition []Remodel ❑Repair ❑T.I. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK: <br /> New construction of 3 story 3 unit townhome, part of a 5 building community <br /> 9 7 Ave- Ind U.,n IT <br /> ACKNOWLEDGEMENT.1 have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> /CIGBiLq�CL 08.11.23 PERMIT# 62-30$— 0 -1-1 <br /> Owner/Authorized Agent Signatur Date (Revised 412112022) <br />