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• BUILDING PERMIT APPLICATION / '�•f;� <br />Applicant To Complete This corm <br />I! more than one building is to be contructed, submit a separate permit applica J/ <br />tion for each building. A separate permit will be issued for /each building. <br />Owner _//d.�A2Aia1 Dim -5 Building Address g(p�� ,196r�ii�o rlf, <br />r <br />Address '762-3 Lot Block <br />City ��SpPhone / A Subdivision (Plat) <br />Archt.tect/Engineer eew) <br />City Phone _ Metes i Bounds (Unplatted) _ <br />Contractor � � CT Sec. /✓3 Twp.%BAI Rge &Wwl <br />Address <br />city Phone Building Us t! <br />State License Number De cri a We Be Done <br />Expiration Date i � 2/a. o , 4, <br />rci <br />Use of Building41 <br />'i2 <br />C✓ <br />, <br />Arnew n Addition ❑ Repair/Remodel <br />valuation of Construction - <br />PLOT PLAN REQUIREMENTS <br />Indicate lot size, name of streets, <br />i•�dicate location and width of <br />allays, locate proposed and all <br />h existing buildings,.show distances <br />to property lines, show distances <br />between buildings / <br />77//x75?< //7/ ,c 26K [ x 2! K 9S <br />Lot size x <br />Lot area AeV Sq. Ft. <br />Size of Bldg; Sq. Ft. <br />Number of StoF es A" <br />Basement <br />Signed By <br />For <br />Owner P on <br />DO NOT WRITE BELOW THIS LINE -FOR CITY USE ONLY / - <br />Date received U_e Zone �_� Q/4_ u� <br />Plan Check Number Fire Zone 3 <br />Valuation <br />Permit Fee <br />Plan Check Fee <br />Total Fee Due <br />Date Issued <br />Occupancy Group _ <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />CITY OF EVERETT <br />APPROVED FOR DUILDING PERMIT <br />