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BuILDING PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 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 I(E)PermitSetvices@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 95%7th AVe SE PARCEL#: <br /> clTy Everett STATE WA ZIP 98208 <br /> SUITEIUNIT M FLOOR M ADDITIONAL LOCATION INFORMATION (if applicable):Chelsea Heights Lot 01 <br /> TENANTIBUSINESS NAME(if non-residential): <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivisiom Chelsea Heights Lot No.:35 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Pacific Ridge Hordes-DR Horton LLC <br /> OWNER MAILING ADDRESS: STREET 17921 Bothell Everett Hwy Ste 100 <br /> cm Bothell STATE WA z E 98012 <br /> OWNER PHONE:425.939.1164 1OWNER EMAIL: RLCIancy@drhorton.COm <br /> CONTRACTOR COMPANY NAME:Pacific Ridge Homes <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):PACIFICRD851JB CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET17921 Bothell Everett Hwy Ste 100 <br /> cay Bothell STATE WA z.. 98012 <br /> CONTRACTOR PHONE:425.939.1164 1CONTRACTOR EMAIL:RLCIancy@drhOrton.Com <br /> PRIMARY CONTACT: El OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425,939,1164 <br /> Rhonda Clancy CONTACT EMAIL:RLClancy@drhorton.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$113(0 ASSOCIATED LAND USE PROJECT#(if applicable):RB2306-001 <br /> (Valuation shall include the prevailing fair market value of 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:New single family residence <br /> HEAT SOURCE: ❑Gas ©Electric ❑Other <br /> BUILDING TYPE: I]SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑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 El Exterior Alteration []Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) OOther:RB2306-001 <br /> DESCRIPTION OF WORK:New single family home using approved Registered Basic RB2306-001 (Thelon AB) <br /> i <br /> i <br /> i <br /> i <br /> i <br /> ACKNOWLEDGEMENT.,t 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.t 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 288.200A WAC. <br /> City of Everett Official Use Only <br /> 02.08.24 PERMIT# 4-D d�0 <br /> I Owner/Authorized Agent Signature Date (Revised 412 1120 2 2) <br />`r <br />"t <br />