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CIf'Y -OF BVERETT <br />PSRN.IT NO.— <br />PrPARTMENT 01' COl"!N:1NLT1' DI:Vrl,OP'.,2N_ <br />BUILDING PTaV-l.CT APi'LICT. '10F <br />VALUATION <br />DATE ,�• <br />PEIC-IIT FEE <br />� y <br />—JC P'• - � •f <br />_ <br />,ADDRESS OF CONSTRUCTION WORIC <br />1 <br />��rF:'�'a;^:� L(��;il <br />�,c(��,C �i^;l (",q^„✓n <br />(;�i,,•�r <br />LEGAL DESCRIPTION: LOT <br />BLOCK <br />PLAT <br />UNPLATTED DESCRIPTION <br />BUILDING DESCRIPTION: NEW <br />ti; ADDITION <br />REMODEL <br />OR REPAIR <br />OF UNITS OCCUPANCY OR US? �• 1'ra. 1,• 5 ' STORIES <br />IS THIS A CHANGE OF BUILDING <br />OCCUPANCY: YES <br />NO <br />CONTRACTOR <br />OWAER <br />6)(A-Mr 7r 37-. <br />MAILING <br />i '�` <br />MATLI27G <br />ADDRESS <br />ADDRESS 473<, <br />PHONE NUMBER <br />PHONE <br />NUMBER 31), 74 yy <br />CONTRACTOR'S LICENSE NUMBER <br />SIGNATURE <br />q <br />NOTE: THE APPLICANT SHALL FILL IN ALL ABOVE BLANKS COMPLETELY INCLUDING <br />THE PLOT PLAN SFFTCII ON REAR OF THIS SHEET. THE APPLICANT IS. RESP0I4SIBLE <br />FOR ALL INFORMATION 1-711ICII IS FURNISHED ON THE APPLICATION. ANY CHANGES <br />IN THE INFORMATION, PLOT PLAN OR BUILDING PLANS SHALL BE SUBMITTED TO THE <br />INSPECTION DIVISION FOR APPROVAL BEFORE PROCEEDINS WITH THE C NSTRUCTION <br />WORK. <br />APPROVAL: ,g <br />1: PLANNING DATE <br />2. ENGINEERING <br />TRAFFIC DIVISION <br />WATER SERVICE <br />SEWER SERVICE <br />PUBLIC SERVICE SECTION <br />":. INSPECTION DEPARTMENT <br />4. FIRE MARSHAL <br />NOTE: ALL CONSTRUC'DIO,'; WORT, S.IALL COMPLY WITH APPLICABLE CODES, 1,10TES <br />ON DRAWINGS, AND INSPGC'PIONS <br />