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fheEue�6'reen �~ �NSTRUCTION r <br />CITY OF <br />eVeY'e� PERMIT PeRMirNo. _ 23 i ��G <br />259-8810 <br />p DEMOLITION ❑ COMBINATION ❑ BUILDING �E7 MECHANICAL C�2 PLUMBING ❑ SIGN <br />O\4NEfi 1AAILADDRE55 GITY Z�P PHONE <br />Greg J. Killough 1813 Madison Everett 98203 353-5071 <br />TENANT MAILAO�RE55 CITY 21P PNONE <br />ARCHITECT OF OESIGNER MqIL AODRE55 CITY 21P PHONE <br />GENERALCONTRACTOR MAILAD�RE55 GITY ZIP PHONE UCENSE� <br />MECHANICALCONTRACtOP MAILAO�PESS GTY ZIP PHONE 4CENSEM <br />GLUMBINGCONTRACTOH MAILAO�RE55 CITY ZIP PHONE LILENSE• <br />Owner <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION X] ALTERATION O HEPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br />CON7RACT PRICE OF WORK: $ <br />pESCRIBE WORN NND SOUARE FOOTAGE INVOWEO <br />Plumbing/Mech <br />PROVOSEO USE OF BUILDING <br />SFR <br />IEGRL DESCRIPTION OF PFOPERTY �SHOW BELOW OR ATTACH FOUf1 COPIES) <br />21 N. Beverly Park <br />LOT - BLOCK - OF <br />JOtl ADORESS <br />1813 Madison <br />PLUMBING <br />NO. TYPE OF FI%TURE Ofi ITFM <br />�. WATER CLOSET (TOILET) <br />1 BATHTUB <br />1 LAVATOFY�WASHBASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />DISHWASHER <br />LAUNDRVTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOLINTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS — RAINLEP DERS <br />SINB �SERVICE — BAR. ETC.1 <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />REAFSETB/CK <br />ZONE �LOTFREA <br />OF STORIES <br />FEE <br />5 <br />S <br />S <br />SIOE SETBACK <br />VACANTSRE <br />❑ YES ❑ NO <br />acrun� «f;,ro,^,�� xo.orov <br />IE SPRINKLERS REO'0 <br />YES ❑ NO <br />BFSEMENT <br />7 YES ❑ NO <br />HEIGMT LIMITFTION <br />IIUNHGG.tlT YLANSAYYHOVtUtlY CITY OF EVERETT <br />LOCALSALES <br />S.x. TAX CODE IS <br />3105 <br />CONTACT PERSON AND PHONE NO. IF OTMER TMAN ABOVE <br />MECHANICAL <br />NO. TVPE OF EOUIPMENT <br />A/C — A/HNDLG UNITS — H.P. <br />FORCEDAIRSYSTEMS— . / 1 <br />UNITHEATERS—B.T.U. /I <br />CLOTHESORYERS �}�} )�� <br />j VENTILATION FAN p ; � <br />RANGEHOOD ��: <br />WATERHEATER � � <br />WOOUSTOVE <br />METAL FIREPLF.CE 8 CHIMNEV <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />CHECKNUMB'cR <br />SU7TOTAL <br />PEHMIT <br />TOTAL FEE <br />FEE <br />BUILDING S <br />PLUMBING <br />MECHAWICAL <br />OTHER <br />STA7E BUILDING SURCHARGE <br />STATEENERGVSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />FEE <br />� <br />5 <br />f <br />RECEIPT NO. <br />I 34 I50 <br />IS YOUR PERMIT <br />PERMITS EXPIRF IF tiVORK IS NOT COMMENr,ED WITHIN ' �" <br />ADI7P�E�:.1'ILf . � <br />100 DAYS GR C[ASr�S FOt� h,70RG THAN 180 �AYS. �� <br />