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• <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> NeigiV <br /> 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 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS- PROPERTY Riverfront Blvd PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Everett Riverfront Simpson Lot No.303 (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 /> cm Bellevue STATE WA ZIP 98005 <br /> OWNER PHONE: (425)586-7700 OWNER EMAIL: connor.king@polygonhomes.com <br /> CONTRACTOR NAME Polygon WLH, LLC <br /> CONTRACTOR ADDRESS: STREET 11624 SE 5th,Suite 100 <br /> aTY Bellevue STATE WA ZIP 98005 <br /> CONTRACTOR PHONE: (425)586-7700 CONTRACTOR EMAIL: ron.bowen@polygonhomes.com <br /> CONTRACTOR LICENSE#(REQUIRED): polygw1863pw CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 053222 <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR ®OTHER(Please Specify) Agent <br /> CONTACT NAME: Connor King CONTACT PHONE:(425)586-7700 <br /> CONTACT EMAIL: connor.king@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 DOther <br /> Building Type: ®SFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ®New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ESprinkler DDemolition DChange of Use <br /> DESCRIPTION OF WORK: <br /> Construct 1 Single Family Residence,2640B Plan Type, 1684 SF living space,428 SF garage&95 SF covered porch,on new <br /> subdivided Division I,70 SF Home Development <br /> ASSOCIATED BUILDING PERMIT#(if applicable): I b 1l-DO i <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: X 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 3 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 2 Bathtub Urinal <br /> Gas Piping Boiler 4 Lavatory(Wash Basin) Drinking Fountain <br /> 1 Water Heater / f f2efiigeratior 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 Other: <br /> 5 Exhaust Fan Sink(Service/Bar/Mop/etc.) Other-. r-61 4 Cp/Th <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 /> PERMIT#C t (,�(6 <br /> o3 <br /> 07/03/19 (/(J(/!l v <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br /> 1 <br />