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PERMIT APPLICATION <br />BUILDING / MECHANICAL / PLUMBING / SIGN ! S— NKLER / 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 />CONTACT.INFORMATION <br />OWNER NAME: Polygon WLH, LLC TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET 11624 SE 5th Street, Suite 100 <br />Bellevue CITY WA STATE 98005 ZIP <br />OWNER PHONE: 425.586.7700 OWNER EMAIL: alan.pani@polygonhomes.com <br />CONTRACTOR NAME: Same as Owner <br />CONTRACTOR ADDRESS: STREET Same as Owner <br />CITY STATE ZIP <br />CONTRACTOR PHONE: 425.586.7700 CONTRACTOR EMAIL:alan.pani@polygonhomes.com <br />CONTRACTOR LICENSE #(REQUIRED): polygwl863pw CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 053222 <br />PRIMARY CONTACT: lQ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: 425.586.7700 <br />Alan Pani CONTACT EMAIL: alan.pani@polygonhomes.com <br />Existing Use of Building: N/a lContract Price of Work: $ <br />Proposed Use of Building: Single Family Home I Heat Source: ❑Gas 10Electric ❑Other <br />Buildinq Type: ®SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Familv-# of Units: ❑Commercial ❑Industrial <br />Type of Project: IN New ❑Addition ❑Remodel ❑Repair ❑T.I. []Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK New construction, single family homes - plan 3581 A, elevationsGarage: 417 sf, 1st floor: <br />1,156 sf, 2nd floor: 1,573 sf and covered porch: 117 sf <br />TED BUILDING PERMIT # (if applicable): #1502-007 <br />ACKNOWLEDGEMENT: l 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. l am the owner, or I 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 />0-&m 'b_ PqA�, 11/14/16 <br />Owner/Authorized Agent Signature Date <br />City of Everett Official Use Only <br />PERMIT # n - ©�-0 , <br />(Revised 10/12/2015) c),,, <br />