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"Rip. PERMIT APPLICATIOhr <br /> BUILDING= I ECHANICAL/ PLUMBING /SIGN -RINKLER/ DEMOLITION <br /> litiad 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:4314 20th Dr.CC L+ ��yS( 6�QPERTY TAX#: 29053200102300 <br /> LEGAL for new construction: Short Plat/subdivision Everett Riverfront-SimpsoniLot No.148 (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 /> carr Bellevue STATE WA ziP 98005 <br /> CONTRACTOR PHONE: (425)586-7700 CONTRACTOR EMAIL: ron.bowen@polygonhomes.com <br /> CONTRACTOR LICENSE#(REQUIRED): polygw1863pw 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 APPLICATION , <br /> Existing Use of Building: N/a Contract Price of Work:$ <br /> Proposed Use of Building: Single Family Home Heat Source: ❑Gas DElectric DOther <br /> Building Type: El SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ®New DAddition ❑Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Construct 1 Single Family Residence,2645A 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 i 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 \ r 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!am authorized by the owner of this property to perform the work for which application is made, <br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. (/0 /�/� City of Everett Official Use Only <br /> D^ �, �` PERMIT# <br /> �"'`an, 1• PaAiu 01/05/18 0/ 1(602--(Z(0 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br /> ci_,..7, <br />