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Il�■Ir L o BUILDING PERMIT APPLICATION E V E R E T T CITY OF EVERETT PERMIT SERVICES SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for roview, WASnlnoTorr (lien drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION:(P)425-257-8810 1(E)PermitServices@everetlwa.gov 1(W)everetlwa.gov/permits (Blue or Black Ink Only Please) Z5 PROJECT SiTE INFORMATION PROJECT SITE ADDRESS: STRFtj_7®S_ P RCEL#1; PORTION OF 00430800004700 cny Everalt STATE WA Zip 98203 SUITElUNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION(if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for newconstruction: Short PlaVsubdivision: Lot No.; '� {attach copy of long legal descripilon) CONTACT INFORMATION OWNER NAME:Robinett Brothers,LLC OWNER MAILING ADDRESS: STREET 116 Avenue C crry Snohomish STATE WA Zip 98290 OWNER PHONE;425-490-2205 OWNER EMAIL: sarah@robinetthomes.com CONTRACTOR COMPANY NAME:Robinett Brothers Construction,LLC WA STATE CONTRACTOR LiCENSE#(REQUIRED);ROBINBC82101 CITY OF EVERETr BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: srREET 116 Avenue C c,Ty Snohomish STATE WA 98290 CONTRACTOR PHONE:425-490-2205 CONTRACTOR EMAIL:sarah@robinetthomes.com PRIMARY CONTACT: B OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-490-2205 Sarah U p i i n r CONTACT EMAIL:sarah@robinetthomes.com BUIL ING INFORMATION VALUATION OF WORK:$45 0 S'�50 ASSOCIATED LAND USE PROJECT#(if applicable):SS19-002&REVI17-027 (valuation shall Intrude trio preval air market value of all labor, (oriels,an egWpment heeded to complete the xnrk,whedier actually paid or not.) EXISTING USE OF BUILDING: PROPOSED USE OF BUILDING: HEAT SOURCE: ❑Gas O✓Electric 001her BUILDINGTYPE: 10SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: OCominercfal ❑Accessory Structure TYPE OF PROJECT(check all that apply): ©New Construction OAddilion ❑Remodel ORepair ❑T.I. OChange of Use ❑Modular OPortabie ❑Re-roof ❑Exterior Alteration OTank(above ground) (]Accessory Structure OFence over 7(t high ❑RackSlorage Pool/Hot Tub ❑Tank(above ground) 130ther_ DESCRIPTION OF WORK; construction of single family residence ACKNOWLEDGEMENT.I have roviewod this applfcatlon and conrirm the inforniaflon conlalned heroin Is true and correct.Work done pursuanl to this permit must comply with curronf federat,stato,and local laiv.The granting ofa permit only authorizes approved work and no deviallons therefrom.Devlatlons must Arst bo authorized in writing from the Building Offlclal before being authorized undorany circumstance.1 am the owner,or I am authorized by the ownarof this property to perform the work for which applicallon fs made, and I comply with the State Contractors Law 18.27 ROW and 296,200A WAC. City or Everett OAlclel Use Only W1 .1 PERMIT#/ i3Z3i05�Ovzad A l Signature Dale (Revised 412112022)