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uUILDING PERMIT APPLICA I ION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETTSUBMITTAL 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 1(E)PermitServices@evereltwa.gov I(W)everellwa.gov/permits <br /> (Blue or Black Ink Only Please) L PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 9506 7th Ave SE PARCEL M <br /> CITY Everett STATE WA ZIP 98208 <br /> SUITEIUNIT M FLOOR M ADDITIONAL LOCATION INFORMATION (if applicable):Chelsea weights Lot 01 <br /> TENANT/BUSINESS NAME(if non-residential): <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Chelsea Heights Lot No.:03 (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 /> CITY Bothell STATE WA ZIP 98012 <br /> OWNER PHONE:425.939.1 164 1OWNER EMAIL: RLCIancy@drhorton.com <br /> CONTRACTOR COMPANY NAME:Pacific Ridge Homes WA STATE CONTRACTOR LICENSE#(REQUIRED):PACIFICRD851 JB CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5 (D_7�y <br /> D <br /> CONTRACTOR ADDRESS: SIRIET17921 Bothell Everett Hwy Ste 100 <br /> clrr Bothell STATE WA ZIP 98012 <br /> CONTRACTOR PHONE:425.939.1164 1CONTRACTOR EMAIL:RLCIancy@drhorton.com <br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425.939.1164 <br /> Rhonda Clancy CONTACT EMAIL:RLCIanc y@drhorton.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $ 3.�3-r 3 ASSOCIATED LAND USE PROJECT#(if applicable):RB2306-003 <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: ©SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial []Accessory Structure <br /> TYPE OF PROJECT(check all that apply): [/]New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use <br /> []Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) []Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage E]Pool/Hot Tub ❑Tank(above ground) OOther:RB2306-001 <br /> DESCRIPTION OF WORK:New single family home using approved Registered Basic RB2306-003 (Hudson AB) <br /> ACKNOWLEDGEMENT:/have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply wilh <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 t 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 Everett Official Use Only <br /> 02.08.24 PERMIT# / O -7 C� <br /> Owner/Authorized Agent Signor ure Date (Revised 412 1120 2 2) <br />