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PERMIT APPLICATION <br /> BUILDIN�ECHANICAL / PLUMBING / SIGN / RINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� w„vw.everettwa.gov/permits <br /> PROJECT SITE INFORMATION 2g0529o04003 2905?_9001021 290529001011 <br /> PROJECT SITE ADDRESS: 3323 3OtI1 DI", Everett, �/A PROPERTY TAX#: 290529001014,005760001000,005760002000, <br /> 004390805017 004390805025 009953000010 <br /> LEGAL for new construction: Short Plat/subdivision ECIIpS2 Lot No.� (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: POlygOfl WLH, LLC TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srREer 11624 SE 5th Street, Suite 100 <br /> Bellevue �,� WA STATE 98005 Z,P <br /> OWNER PHONE: 425.�JHG.77OO OWNER EMAIL: 818n.paC11 Q�pOlygOnh0171eS.COlII <br /> CONTRACTOR NAME: Saf11e 8S OWtI@I" <br /> CONTRACTOR ADDRESS: srkEEr Same as Owner <br /> GTY STATE ZIP <br /> CONTRACTOR PHONE:4Z5.�JH6.77O0 CONTRACTOR EMAIL:8I8f1.p8111@pOI�/gOC1I10t71eS.00171 <br /> CONTRACTOR LICENSE#(RE4UIRED): pOIygWI863pW CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): OrJ3222 <br /> PRIMARY CONTACT: [$OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425.58C.77OO <br /> Alan Pani coNr,acT Ennai�: alan.pani@polygonhomes.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: N/8 Contract Price of Work: $ <br /> Proposed Use of Building: MUItI-F8IT11Iy TOWf1flOCT1eS Heat Source: ❑Gas �Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex �Multi-Family-#of Units: 6 ❑Commercial ❑Industrial <br /> Type of Project: �New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: C011StfUCt Ulllt 'I D ICl Bldg 20.2, a Type B - 6 unit building, as part of a 190 Unit Townhome <br /> Development <br /> 6-plex unit is 11,005 total SF, plan type E1 D is 1,344 SF, 322 sf garage, and 95 sf porch/patio <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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 #of <br /> List of Fixtures List of Fixtures #of List of Fixtures #of List of Fixfures <br /> Fixtu�es Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump 3 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater � Bathtub Urinal <br /> Gas Piping Boiler 3 Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> � Gas Fireplace Wood Stove x' Kitchen 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 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 herein is true and correct.Work done pursuant to this pe�mit must comply with <br /> current federal,state,and local law. The granting of a permit on/y authonzes approved work and no deviations therefrom.Deviations must firsl be authorized in writing from the <br /> Building Official before being authorized under any circumstance.1 am the owner,or 1 am authorized by the owner of this property to perform the work fo�which applicalion is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Cify o(Everett Official Use Onfy <br /> PERMIT# t l <br /> l�t�L �_ �A.11,t. 04.06.16 C � � �'L�` C�,,�1 <br /> OwnerlAuthorized Agent Signature Date (Revised 10/12/2015) <br />