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1 <br /> .iii <br /> I PERMIT APPLICATIO <br /> igoeiti, <br /> �' BUILDIN�CHANICAL/ PLUMBING /SIGN RINKLER/ DEMOLITION <br /> �, /'/ CITY OF EVERETT PERMIT SERVI <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> ,,PROJECTSITE INFORMATION '; , <br /> PROJECT SITE ADDRESS: PROPERTY 30th Dr.SE PROPERTY TAX#: 29053200102300 <br /> LEGAL for new construction: Short Plat/subdivisionEverett Riverfront Simpson Lot No.158 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Polygon WLH,LLC TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 11624 SE 5th,Suite 100 <br /> cITY 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 IXI 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 ❑Electric ❑Other <br /> Building Type: IXISFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: IX—INew ❑Addition ❑Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Construct 1 Single Family Residence,3577A Plan Type,2729 SF living space,417 SF garage&117 SF covered porch,on new <br /> subdivided Division I,70 SF Home Development <br /> 0 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): #1502-007 <br /> MECHANICAL PERMIT APPLICATION ,i 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 /> NC—Air Handling Units Heat Pump 3 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 3 Bathtub Urinal <br /> Gas Piping Boiler 5 Lavatory(Wash Basin) Drinking Fountain <br /> 1 Water Heater 1 Refrigeration 1 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 1 Water Heater 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. 1 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 /> PERMIT# <br /> ata-n, 1. Pte04.18.16 <br /> , CI (lY V^n CO` 01A <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) 1 <br />