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0 PERMIT APPLICATION <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS:4628 Riverfront Blvd <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Everett Riverfront -Simpson Lot No.368 (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 />clTv Bellevue STATE WA ZIP 98005 <br />OWNER PHONE: 425.586.7763 <br />OWNER EMAIL: connor.king@polygonhomes.com <br />CONTRACTOR NAME: Polygon WLH, LLC <br />CONTRACTOR ADDRESS: STREET 11624 SE 5th, Suite 100 <br />clTv Bellevue STATE WA ZIP 98005 <br />CONTRACTOR PHONE: 425.586.7763 <br />CONTRACTOR EMAIL: ron.bowen@polygonhomes.com <br />CONTRACTOR LICENSE #(REQUIRED): polygwl863pw <br />I CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 053222 <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ® OTHER (Please Specify) Agent <br />CONTACT NAME: Connor King <br />CONTACT PHONE: 425.586.7763 <br />CONTACT EMAIL: connor.king@polygonhomes.com <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: N/a <br />Contract Price of Work: $ 60.� <br />Proposed Use of Building: Single Family Home <br />Heat Source: []Gas ❑Electric ❑Other <br />Building Type: ®SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi -Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ®New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign []Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />New construction, single family homes - plan 3581N 9 &It elevations <br />Garage: 417 sf, 1st floor: 1,156 sf, 2nd floor: 1,573 sf and covered porch: 117 sf <br />ASSOCIATED BUILDING PERMIT # (if applicable):-" S DO Z <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: X New _ Addn _Alteration _Repair <br />Type of Project: X New _Addn _Alteration _Repair <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />A/C —Air Handling Units <br />Heat Pump <br />3 <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />2 <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />5 <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />1 <br />Water Heater <br />n <br />2 <br />iShower <br />Floor Drain <br />1 <br />Gas Fireplace <br />Wood Stove <br />1 <br />Kitchen Sink & Disposal <br />Grease Trap <br />Gas Range <br />Ducting <br />1 <br />Dishwasher <br />Roof Drains <br />1 <br />Clothes Dryer Hookups <br />Other: <br />1 <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />ea <br />Other: W <br />7 <br />Exhaust Fan <br />Sink (Service/Bar/Mop/etc.) <br />Other: <br />SPRINKLER <br />/ SUPPRESSION <br />SYSTEM <br />Number of Heads <br />ACKNOWLEDGEMENT: / 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 / am authorized by the owner of this property to perform the work for which application is made, <br />and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Co-mnz,Z. ckli. 07/8/19 <br />Owner/Authorized Agent Signaffire Date <br />City of Everett Official Use Only <br />PERMI� I I <br />bl�— <br />(Revised 10/12/2015) (�/Z <br />