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bvILDING PERMIT APPLICATON <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) 9 50 g PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: sTREET95067th Ave SE PARCEL#: <br /> crry Everett STATE WA 21P 98208 <br /> SUITEIUNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable):Chelsea heights Lot 01 <br /> TENANT/BUSINESS NAME(if non-residential): <br /> LEGAL DESCRIPTION for newconstruction: Short Platlsubdivision: Chelsea Heights Lot No.:02 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Pacific Ridge Homes- DR Horton LLC <br /> OWNER MAILING ADDRESS: smEET 17921 Bothell Everett Hwy Ste 100 <br /> clrr Bothell sTATE WA ziP 98012 <br /> OWNER PHONE.,425.939.1164 OWNER EMAIL: RLClancy@drhorton,com <br /> CONTRACTOR COMPANY NAME:Pacific Ridge Homes <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):PACIFlCRD851 JB CITY OF EVERETT BUSINESS LICENSE#/(REQUIRED):C (0 f o 3 <br /> CONTRACTOR ADDRESS: STREET17921 Bothell Everett Hwy Ste 100 <br /> cIn Bothell STATE RYA 2p 98012 <br /> CONTRACTOR PHONE:425.939.1164 CONTRACTOR EMAIL:RLClancy@drhorton.com <br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425.939,1164 <br /> Rhonda Clancy CONTACT EMAIL:RLClancy@drhotton.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $' 3 4 ASSOCIATED LAND USE PROJECT#(if applicable):RB2306-005 <br /> (Valuation shall include the prevaging fair market value of all labor,materials,and equipment needed to complete the work,whether actualty paid or not.) <br /> EXISTING USE OF BUILDING:NIA <br /> PROPOSED USE OF BUILDING:New Single family residence <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:R62306-001 <br /> DESCRIPTION of WORK:New single family home using approved Registered Basic RB2306-005 (Lennon AB) <br /> f <br /> I <br /> i <br /> I <br /> i ACKNOWLEDGEMENT:f 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 t comply with the State Contractors Law 18.27 RCW and 298.200A WAC. <br /> I City of Everett Ofiicta!Use Only <br /> PERMIT# <br /> 02.08.24 la Zft b� <br /> i Owner/Authorized Agent Signatifie - - Date (Revised 412112022) <br /> E <br /> i <br /> r <br /> E <br />