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BUILDING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box, CONTACT INFORMATION:(P)425-257-8810 I(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ilk Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: sTaEE EL#: PORTION OF 00436800004700 ciTY Everett STATE WA 2,p 90203 SUITElUNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION({(applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (allach copy of long legal description) CONTACT INFORMATION OWNER NAME:Robinelt Brothers,LLC OWNER MAILING ADDRESS: STREET 116 Avenue C crry Snohomish STATE WA up 98290 OWNER PHONE:425-490-2205 OWNER EMAIL: sarah@robinetthomes.com robinetthomes.Com CONTRACTOR COMPANY NAME:Robinett Brothers Construction,LLC WA STATE CONTRACTOR LICENSE#(REQUIRED):ROBINBC821 Q1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET 116 Avenue C crry Snohomish STATE WA z1P 98290 CONTRACTOR PHONE:425-490-2205 CONTRACTOR EMAIL:sarah@robinelthomes.com PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) ' CONTACT NAME: CONTACT PHONE425-490-2205 Sarah Uplinger CONTACT EMAIL:sarah@robineithomes.com B ILDING INFORMATION VALUATION OF WORK:$45 0 SLAKASSOCIATED LAND USE PROJECT#(if a licable):SS19-002&REVIi7-027 (Valuation shall Include the prevatli air marketvalue of all la ,materials,and equipment needed to complete the work,whotheracluaBy pa erne(.) EXISTING USE OF BU DING: PROPOSED USE OF BUILDING: HEAT SOURCE: ❑Gas I]Electdc ❑Other BUILDING TYPE: ❑✓SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Farnily-#Units; ❑Commerclal ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑✓New Construction ❑Addition ❑Remodel ❑Repair ❑T,I. ❑Change of Use ❑Modular ❑Portable ❑Re-roof ❑EXteTIOr Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: construction of single family residence ACKNOWLEDGEMENT.•I have reviewed this appkation and confirm the Information contained hsrein is true and correct.Work done pursuant to Oris pormll must comply with current fedatal,state,and locallaw.The granting of a permit onfyaufhorizos approved ivork and no deviations therefrom.Doviatlons t))ust first be aufhorized in tviiling from tl)e Bullftg Orflclar before being authorized under any circumstance.tam the owner,or 1 am authorized by the owner of this property to pattern)the work for which application is made, and I comply tMh the State Contractors Law 18.27 RCW and 298.200A WAG. City ofEverell OfOctal Use Only *, rIA.0.,-1 7J �� PERMIT#9.dA4g,, ignature to (Revised 412112022)