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PERMIT APPLICATNI <br /> (001EFIFT BUILEHHU / MECHANICAL/ PLUMBING/SICPRINKLER/ 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- PROPERTY 30th Dr.SE PROPERTY TAX#: 29053200102300 <br /> LEGAL for new construction: Short Piat/subdivision Everett Riverfront-Simpson Lot No.227 (attach copy of long legal description) <br /> CONTACT INFORIVIAT-ION`` = <br /> OWNER NAME: Polygon WLH,LLC TENANT NAME(If 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 /> cm, Bellevue STATE WA BP 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 ID OTHER(Please Specify) Agent <br /> CONTACT NAME: Alan Pani CONTACT PHONE:(425)586-7700 <br /> CONTACT EMAIL: alan.pani@polygonhomes.com <br /> BUILDING:PERMIT APPLICATION " <br /> Existing Use of Building: N/a Contract Price of Work:$ <br /> Proposed Use of Building: Single Family Home Heat Source: ❑Gas El Electric ❑Other <br /> Building Type: ®SFR-Detached ❑SFR-Attached El Duplex ❑multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ®New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Construct 1 Single Family Residence,2640A Plan Type,1684 SF living space,428 SF garage&95 SF covered porch,on new <br /> subdivided Division I,70 SF Home Development <br /> ASSOCIATED BUILDING PERMIT#(if applicable):#1502-008 <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 4 Lavatory(Wash Basin) Drinking Fountain <br /> 1 Water Heater i er 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 ate Other: <br /> 5 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 /> City of Everett Official Use Only <br /> I/da h PPERMITu'lbl/ t 0, <br /> Patti, 02/09/2017 U I4 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />