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{ t <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN I 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE,INFORMATION <br /> PROJECT SITE ADDRESS:4413 30th Dr.SE PROPERTY TAX#: 29053200102300 <br /> LEGAL for new construction: Short PlaUsubdivisionEverett Riverfront-Simpson Lot No.237 (attach copy of long legal description) <br /> CONTACT INFORMATION:. <br /> OWNER NAME: Polygon WLH,LLC TENANT NAME(1lf Commercial): <br /> OWNER MAILING ADDRESS: STREET 11624 SE 5th,Suite 100 <br /> cry 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: 0 OWNER 0 CONTRACTOR ®OTHER(Please Specify) Agent <br /> CONTACT NAME: Alan Pani CONTACT PHONE:(425)586-7700 <br /> CONTACT EMAIL: alan.pani@polygonhomes.com <br /> BUILDING PERMIT 3APPLICATION <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: ®SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ['Commercial ['Industrial <br /> Type of Project: ®New DAddition ['Remodel ['Repair ❑T.I. DSign ❑Sprinkler ❑Dem olition ['Change of Use <br /> DESCRIPTION OF WORK: <br /> Construct 1 Single Family Residence,2645C Plan Type,1910 SF living space,438 SF garage&98 SF covered porch,on new <br /> subdivided Division I,70 SF Home Development <br /> ASSOCIATED BUILDING PERMIT#(if applicable): #1502-009 <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 5 _Lavatory(Wash Basin) Drinking Fountain <br /> 1 _Water Heater 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 t Other: <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 /> nn ,�, -- City of Everett Official Use Only <br /> Uted b_ l�a.rw 02/09/17 <br /> PER <br /> Owner/Authorized Agent Signature Date (Revised <br /> O/?2/2015) <br />