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BI DING PERMIT APPLICAT N <br /> D ECEIN , <br /> CITY OF EVERETT PERMIT SERVICES JUL 1 <br /> EVERETT SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements n number of coes'r red for./ iew, <br /> WASHINGTON then drop off completed application plus all required submittal documents to 3200 I op Box. <br /> CONTACT INFORMATION: (P)425-257-8810 I (E)PermitServices@everettwa.gov I( e�, . <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PCfftllt vCr\(II. ' <br /> PROJECT SITE ADDRESS: STREET 535 View Ridge Drive PARCEL#: 004647 000 062 01 <br /> clry Everett STATE WA ZIP 98203 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:J & S Development LLC <br /> OWNER MAILING ADDRESS: STREET 22621 57th Ave SE <br /> arY Bothell STATE WA ZIP 98021 <br /> OWNER PHONE: 425-870-8922 OWNER EMAIL: bstrootman@msn.com <br /> CONTRACTOR COMPANY NAME:J & S Development LLC �y j� <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):JSDEVSD878JN CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6 6 l { CJ <br /> CONTRACTOR ADDRESS: STREET22621 57th Ave SE <br /> CITY Bothell STATE WA ZIP 98021 <br /> CONTRACTOR PHONE: 425-870-8922 CONTRACTOR EMAIL:bstrootman@msn.com <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR ✓❑OTHER (Please Specify) Civil Eng <br /> CONTACT NAME: CONTACT PHONE:425-773-9567 <br /> Bob Nehring, PE Sound Design Eng CONTACT EMAIL:bob.sdeng@gmail.com <br /> Q�^ BUILDING INFORMATION <br /> VALUATION OF WORK: $O0,0 ?q IO ASSOCIATED LAND USE PROJECT#(if applicable): QW a,3o 7 - Oo <br /> (Valuation shall include the prevailing fair market value of all latl6r,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING: Vacant Lot <br /> PROPOSED USE OF BUILDING:Build SFR model 4335 <br /> HEAT SOURCE: ❑Gas ❑Electric ❑Other <br /> BUILDING TYPE: ©SFR ❑Townhouse ❑Duplex LIADU ❑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: <br /> DESCRIPTION OF WORK: <br /> Build new house model 4335 with Driveway and utilities <br /> - &cJ O/I/1 — L/ EA-TR <br /> 5. n r <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 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 /> ‘'1141(0, <br /> PERMIT# <br /> ,6ti,,,,/ 6/26/23Bc2- 3O7 (,�r�e <br /> Owner/Authed Agent ignature Date (Revised 4/21/2022) <br />