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BUILDING PERMIT APPLICAi iION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETTSUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, <br /> WASHI1407ON 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) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 9506 7lh Ave SE ✓ PARCEL#: <br /> CITY Everett STATE WA zlP 98208 <br /> SUITEIUNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable):Chelsea Heights Lot0i <br /> TENANT/BUSINESS NAME(if non-residential): <br /> LEGAL DESCRIPTION for new construction: Short PlaUsubdivision: Chelsea Heights Lot No.:01 (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 /> ctn Bothell STATE WA ZIP 98012 <br /> OWNER PHONEA25.939.1164 1OWNER EMAIL: RLClancy@drhorton.com <br /> CONTRACTOR COMPANY NAME:Pacific Ridge Homes <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):PAC I FIC R D851 JB CITY OF EVERETT BUSINESS LICENSE 1f(REQUIRED}: <br /> CONTRACTOR ADDRESS: STREET17921 Bothell Everett Hwy Ste 100 <br /> crry Bothell STATE WA ZIP 98012 <br /> CONTRACTOR PHONEA25.939.1164 CONTRACTOR EMAIL:RLClancy@drhorton.com <br /> PRIMARY CONTACT: [DOWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425,939,1164 <br /> Rhonda Clancy CONTACT EMAIL:RLClancy@drhorton.corn <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$, S(01, g�� _ ASSOCIATED LAND USE PROJECT#(if applicable):RB2306-001 <br /> (Valuation shall include the prevaling fair market value of all labor,materials,and equipment needed to complete the work,whether actualty paid or not.) <br /> EXISTING USE OF BUILDINGMA <br /> PROPOSED USE OF BUILDING:New single family residence <br /> HEAT SOURCE: ❑Gas ©Electric ❑Other <br /> BUILDING TYPE: ❑✓SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial []Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑d New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessary Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) 00ther:RB2306-001 <br /> DESCRIPTION OF WORK: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.1 am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 02.08.24 PERMIT# Z ` /� r Q' <br /> VIIJO <br />[ Owner/Authorized Agent Signature Date (Revised 412112022) <br /> I <br />