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BUILDING PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT <br /> SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, <br /> wASHINGTOH 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!E ¢7_: PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: sTREET 95e6-1th AVe SE PARCEL#: <br /> CITY Everett STATE WA Z,p 98208 <br /> SUITEIUNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable):Chelsea Heights Lot of <br /> TENANT/BUSINESS NAME(if non-residential): <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Chelsea Heights Lot No.: 13 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Pacific Ridge Homes- DR Horton LLC <br /> OWNER MAILING ADDRESS: STREET 17921 Bothell Everett Hwy Ste 100 <br /> clTY Bothell STATE WA z.. 98012 <br /> OWNER PHONE:425.939.1164 IOWNER EMAIL: RLClancy@drholton.Com <br /> CONTRACTOR COMPANY NAME:Pacific Ridge Homes <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):PAC]FICRD851 JB CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STRIET17921 Bothell Everett Hwy Ste 100 <br /> crnr Bothell STATE WA zIP 98012 <br /> CONTRACTOR PHONE:425.939.1164 1CONTRACTOR EMAIL:RLClancy@drhorton.com <br /> PRIMARY CONTACT: EI OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425.939.1 164 <br /> Rhonda Clancy CONTACT EMAIL:RLClancy@drhorton.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$5209ft.trCr X e, q 5o 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: ZSFR ❑Townhouse ❑Duplex ❑ADU []Multi-Family-#Units: []commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ✓❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.1. ❑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) OOther:RB2306-001 <br /> DESCRIPTION OF WORK: <br /> New single family home using approved Registered Basic RB2306-001 (Thelon AB) <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./am the owner,or!am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of EverettOfficial Use Only <br /> / 03.07.24 PERMIT# N 2- ! v 3— O��L <br /> OwnertAuthorized Agent Signat Date (Revised 412112022) <br />