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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER / DEMOLITION <br /> 1� T CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS•:4527 Riverfront Blvd PROPERTY TAX#: 29053200102300 <br /> LEGAL for new construction: Short PlausubdivisionEverett Riverfront-Simpson Lot No.14 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Polygon WLH,LLC TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 11624 SE 5th,Suite 100 <br /> crry 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 /> crry 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 ❑CONTRACTOR E 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 ❑Electric ❑Other <br /> Building Type: ESFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ®New ❑Addition ❑Remodel El Repair DTI. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Construct 1 Single Family Residence,2645A Plan Type, 1910 SF living space,438 SF garage&98 SF covered porch,on new <br /> subdivided Division I,70 SF Home Development <br /> ASSOCIAT BUILDING PERMIT#(if applicable): #1502-0119-- OA!) 1,q)11-1 <br /> ECHANICAL PERMIT APPLICATION A PLUMBING PERMIT APPLICATION <br /> Type of Project: X New — Addn _Alteration Repair Tyof 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 3 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 2 Bathtub Urinal <br /> Gas Piping Boiler 5 Lavatory(Wash Basin) Drinking Fountain <br /> 1 Water Heater \ /Refrigeration 2 Shower Floor Drain <br /> 1 Gas Fireplace Wood Stove 1 Kitchen Sink& Disposal Grease Trap <br /> Gas Range Ducting 1 Dishwasher Roof Drains <br /> 1 Clothes Dryer Hookups Other: 1 Clothes Washer Medical Gas <br /> Range Hood �A\,\ /-Water-Heater - - 1 Other:W /MM(,2_,,_?,y,.,& <br /> 6 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 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.I am the owner,or I am authorized 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 /> O.Ga i h. Pante PERMIT toZ- 002J <br /> 10/05/18 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br /> 0 <br />