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� ;l �.-`'`-�� � _. <br />. • noz�,�iNc rr•,�zi�zT nrrLicn�r=oN � > � J�- ,� ' `. <br />. . . -� ; � <br />• ilpplicant To l,omp:cete 7`his 1'orm ' l,-� ;��� <br />If more than one building i,�to be con�trucL•ed, submit a separ.at•e rer.mi.t• <br />appli��aL•ion for cach building. A �eparate ��crmit aii.11 Ue i��ucd for. cacli <br />building. , ,/% . <br />Ovmer ���i , u!� �f ��tG'�u2ati Gl�.✓ riuilding 7+ddress ��.5" �y/�+-��<��. <br />Address QH�,7,3 -,3,�i`"'�� �•�n�. Lot t3locl: <br />City �r,�P?��-U Phone 3 -S-ioB Subdivision (P1aL-) • <br />, • <br />Archi:cct/�ngincer �n-»*.e. <br />City 1'honc Mete, &'IIound� (Unplattccl) <br />Contrector ,�7�-,�✓_/ Sec.'_ �% T�ap. �`� � _ Rge.� �cv�> <br />Addrt-ss <br />City Phonc • _ <br />Statc License l.umbera�3•o/. /06�� <br />Er.piration Date ,�-�2�• 76 <br />CO]-PT.,:�" PLOT PLItt7 037 IiEVE1SE S1D� <br />d <br />IIuilding Usc �%`77e..a'c�✓�-.✓ J�.�. <br />� Descr,ihe i4ork to �e llone <br />Lnr� /7 ..0�( /� �-G�A-�'-sa�J lt,rt�cl..�c o�-J <br />Number of Stories � <br />IIasement �� <br />� �- <br />" l�ew� Additiot Repai�r.,�Remodel' <br />Valuation of Consiruction 7Cn,ron°-' <br />C-�-�-ux.,J a�,- �3 - � ✓-.�.s_ <br />Siqned IIy � � �t��-xJ <br />. FoL .�i�l� � . /' rz-(d�-,.�J <br />Owner • Phor�e33 ✓-�5`/08 <br />�L• T9ritc Be].ow Thi� Li.nc -T'or Cit! <br />Date Received 2l���p"%7�"' " <br />�lan C;�ecl: Number �--�-7 iin`-%(d`. <br />0 <br />Valua:ion �P c9C� " � ' • <br />Perriit Fee • 3(p- �� <br />Plan Check T'ce • Z������ <br />Tot•al i'ec llue �� �'� <br />Datc Ts�ucd <br />' • ` Use Sonc �,�-Z� • <br />---r <br />i rirc� 2one _ _ 3 <br />Occupancy•Group 4I <br />Typc of Construction �_t,1 " <br />Occupant Load <br />Sprinlclers Requircd <br />CITY OF EVERETT <br />� � APPROVED FOFt BUILDING PERMIT <br />z1.•: "��,_ey_,�,,,--" <br />oate �, <br />—.� �1 <br />