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PERMIT APPLICATF; <br /> BUILDII'�' :' MECHANICAL/ PLUMBING / SIG SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: !PROPERTY Riverfront Blvd Everett,WA !PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivisionEverett Riverfrontf trot No. (attach copy of long legal description) <br /> CONTACT INFORMATION ;Y' : <br /> OWNER NAME: Polygon WLH. LLC TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 11624 SE 5th,Suite 100 <br /> cin Bellevue STATE WA Zip 98005 <br /> OWNER PHONE: (425)586-7700 OWNER EMAIL: alan.pani©polygonhomes.com <br /> CONTRACTOR NAME: Polygon WLH, LLC <br /> CONTRACTOR ADDRESS: STREET 11624 SE 5th,Suite 100 <br /> CITY Bellevue STATE WA ZIP 98005 <br /> CONTRACTOR PHONE: (425)586-7700 CONTRACTOR EMAIL: ron.bowen@polygonhomes.com <br /> CONTRACTOR LICENSE#(REQUIRED): polygwl863pw CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 053222 <br /> PRIMARY CONTACT: ❑ OWNER El CONTRACTOR 1i OTHER(Please Specify) Agent <br /> CONTACT NAME: Alan Pani CONTACT PHONE:(425)586-7700 <br /> CONTACT EMAIL: alan.pani@polygonhomes.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: N/a Contract Price of Work: $ <br /> Proposed Use of Building: Single Family Home Heat Source: ❑Gas 0 Electric ['Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial Ellndustrial <br /> Type of Project: El New ❑Addition ❑Remodel El Repair ❑T.l. E7n ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 72 4 W <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IMECHANICAL PERMIT APPLICATION PLUMBI PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: X New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump —'Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater — 3athtub Urinal <br /> Gas Piping Boiler — _avatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration —;Shower Floor Drain <br /> Gas Fireplace Wood Stove _<itchen Sink& Disposal Grease Trap <br /> Gas Range Ducting —Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other. Clothes Washer Medical Gas <br /> Range Hood Water Heater 1 Other: • ••••»• ••• •• <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained'erein 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 a/d no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance. I am the owner,or I am authonzed by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> � � PERMIT# <br /> //�� <br /> t�l,�Gi& 'h_ Po—nA. 04/12/17 _ r Lt'0( <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />