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theEuergreen �,NSTRUCTION ~ � <br />CITY OF <br />everett PEF�MIT PERMITNO. 2`+001 <br />259-8810 <br />❑ DEMOLITION ❑ COM8INATION ❑ BLILD�NG �LYAECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER HeleR MAILFU�RESS CITY ZIP pHONE <br />� ���yj,�k 1814 D1adi son <br />rE"a"T$pUCe (contact person-diQl4@`i°Ri� elderly)� cirv ziv PHONE <br />��` '��db��'���8`�#�E-��C����@CGC�i.. cirv �za -9(1RR PMONE <br />i CHITECT OB DES�GNER MqIL AO�RE <br />IAFIL40�RE55 CITY ZIP PHONE UCENSFM <br />MECHANILALCONTRACTOR MAILADORESS pITY ZIP PMONE 4LENSE• <br />MAIL <br />CLAGS OF \�CRN <br />p NEW ❑ ADDITION �] pLTERATI�N C f1EPAIR <br />CONTRACT PRI�E OF WORK: $ <br />Install Conversion IIurner <br />CITY 21P <br />❑ DEMOLITION <br />�� <br />❑ BUILDING RELOCATION <br />W NTAGT PERSON ANO PHONE NO. IF GTMER THAN A90VE <br />Sin�le Fanulv Residence <br />PqOPOSED USE OF pUILDING <br />03/OS/�0 5:45Pti OOOqq0265 :t-'kk:k <br />LEGAL DESCRIPTION OF PROPERTY �SIIOW BELOW OR ATTACh FOUR COFiES� � <br />uM00e�024048 <br />LOT _ B�OCK _ OF — 1'IEGI� S�]S � <br />H000^c4049 <br />1814 hladison H00024050 <br />�osnooness • <br />#00024061 <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVAiORV�WA5H8ASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />OISHWASHER <br />l4UNORVTRAV <br />CIOTHES WASHER <br />URINAL <br />ORINKING FOUNTAIN <br />FI.GOR DRAIN <br />OpCKFLOW PREVENTEfiS <br />.IOOF DRAINS — RAIN:EADEFS <br />SINK (SERVIGE — BAP. ETC.1 <br />OF <br />OF <br />SUBTOTAL <br />PEPMIT <br />TOTALFEE <br />REAR SET[iACH <br />LOT AREA <br />ttPE OP CON57RUCilON ACiOId <br />NO.OF STORIES <br />FIRE SPRINNLERS REO'0 <br />❑ VES ❑ NO <br />MECHANICkL � <br />FEE NO. TY�EOFEOUIPMENT <br />A/C — A/HNDLG UNITS — H P. <br />FORCEDAIRSVSTEMIS—d.T.U. M <br />UNITHEATERS—B.T.L'. M <br />SiOE SETBACK <br />VACANTSRE <br />] YES ❑ NO <br />rcnm.nr,r �10 OF OIVELIIqC <br />DASEMENT <br />] YES ❑ NO <br />li[IGHT LIMITATION <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS <br />3105 <br />VENTILATION FAN <br />RANGEHOOD <br />WATERHEATER <br />WOODSTOVE <br />METAL FIREP! ACE 8 CHIMNEV <br />FIflEPLACEINSERT <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SI1B 70TAL <br />PEqM'IT <br />TOTALFEE <br />FEE <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTMER <br />STATE BUILDIN� SURCHARGE <br />STA7EENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />WHEN PROPERLY Vp <br />� <br />S <br />S <br />RECEIPT NO. <br />45 <br />� 4s <br />THIS IS YOUR PERMIT <br />PERMITS EXPIRE IF WORK IS NOT COMMENCED WITHIN ADDRESS FILE [, �� �� i� � <br />180 DAYS OR CEASES FOR MORE THAN 180 DAYS. ' <br />