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BUILDING PERMIT APPLICATION �/ 76 •• <br />Applicant: To Complete TI•is Form / <br />If more than one building is•t-o be constructied, submit a Separate permit <br />application for each building. A scparatc pci:mit will be issued for each <br />building. <br />Owner .() 'y �Z /--! &__" _ <br />Address <br />City d" t Phone <br />Architect/Engineer 1/K L- <br />City Phone <br />Building Addicss/J.:= Jr...� <br />Lot �+ `� Block f <br />Subdivision (Plat) <br />yid <br />Metes & Bounds (Unplatted) <br />Contractor 7o,- c S •i ,T>-ram, 3 LSec. <br />Address / Lf'O -/tic .<� ��. _� • _ <br />City tcJz- .<T Phone '5-S S <br />State License Number 2 � } O l /4 9G3 <br />Expiration Date 4 -/- % C <br />Twp. _ Rge. <br />Building Uself <br />Describe Eork to Be /Done <br />%� <br />COI= PLOT PLAN ON REVERSE SIDE <br />Number of Stories <br />Basement <br />New ,.c.uicawi .Repair. Remode]�- <br />Valuation of Construction $ <br />Signed By z <br />For <br />Owner Phone <br />Do Vot [•;rite Below This Line. -For City use Only <br />Date Received a Z7Cn '''''' Use Sone <br />clan Cneck Number 7Firo zone <br />Valuation f�- L� �' Occupancy -Group - - i 1 _ <br />Perr.it Fee 2 2. n U Type of Consi:ruction <br />Plan Chcck Fee U Occupant Load <br />Total Fce Due Sprinklers Required <br />Date Issuccl <br />CITY OF EVERETT <br />APPROVED'FOR BUILDING PERMIT, <br />