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PERMIT APPLICATION• <br /> BUILDINCECHANICAL/ PLUMBING /SIGN I I''RINKLER/ 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.INFORMATIONry,, ,. a;__ <br /> PROJECT SITE ADDRESS:4422 30th Dr.SE PROPERTY TAX#: 29053200102300 <br /> LEGAL for new construction: Short Plat/subdivisionEverett Riverfront-Simpson Lot No.232 (attach copy of long legal description) <br /> 4 t° ,- . ., x 4^, C`ONTACT`'INF,OR.MATION ' <br /> OWNER NAME: Polygon WLH,LLC TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 11624 SE 5th,Suite 100 <br /> civ 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 /> CITY 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 Existing <br /> N- <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 ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑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 s ,.y,; PERMIT.A <br /> . PPLICATION <br /> a V <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 /> NC-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 ----f 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 e , 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.lam the owner,or 1 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 /> n <br /> lel�� _ �/ PERMIT#C o�— �/ <br /> A.� �_ �A, 02/09/17 I� <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) ,,, <br />