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BUILDING PERMIT nPPLICTTION <br />Applicant To Complete This Form <br />� ��7 3 <br />��� ���s <br />r If more than one building is to be constructed, submit a separate permit ap- <br />' plication for each building. A separate permit will be issued ior each build- <br />� — inq. <br />Owner�dQpNO %i'GOfrbc�' Building nddress �� 6�'/p C:U�l3v <br />naar�ss �9io � G'o,G /3� r.ot 3 nix;�'�,r��8s��. <br />City �6�L`iPL- T � Phone Twp. Rge. <br />Architect ' Subdivision (Plat) .�rl��J'-L+='� �'�/�-� <br />.... ...... .Y ......_ ........ ............,.. .. .......... ... . .. .. . ... . . . ..,. . ... . ....,............. . <br />. .. _ .. . .. ..... <br />� Cit� Phone Metes & T3ounds (Unplatted) <br />Contractor�S'T/>li/E'� L L _,�� <br />. <br />Address .% �7 _�n ,�p Gt�fY' <br />City,�//���` 7"T Phone:ZSy'S,S`,�� IIuilding Use ,S'%O/PilC'� _ <br />State License Number'22��'n/- �'.2yp Describe Work to De Done <br />Expiration Date <br />�' ; Use of Buildi ng ,j' 7`t �PLl R.'� <br />., <br />��� '— New . Addition . Repair/fienodel <br />i <br />' Valnation of Constructi,on $ �Oe7G, aa <br />PLOT PLAN <br />In�icate lot size, name o� streeY.s, <br />�� indicate location and width of <br />�; - allcys, locate pxoposed and all <br />existing Uuildin9s, show clistances <br />! to property lines, show distances <br />j;: between buildings. <br />t' <br />,_---r -- --_ <br />� ! <br />''" � �nn taom <br />Cate Reccived Zf 7 1 r <br />Plan Check Number � S�-3vq <br />Valuation 2-��c°�C� • ��� -� <br />Pcrmil Pee �= v ' <br />Plan Check Fee l � <br />Total Fce Due J �- ��= � <br />Permit NumUcr ���% 7�� <br />Dalc Issucd� � l�7 ) <br />LoL- size x <br />� � �Lot arca S.F. <br />� Size of llldy. S.P. <br />NumUer of Stories <br />llasement <br />Use Zone <br />� - / <br />signed' BY��i� , , `ft:is: •..s..,-�GJ <br />Por <br />Owner <br />�l9 T11I5 L7WC-AOR CITY '� <br />Fire <br />Type oi Construction� � -��� <br />Occupancy Group j <br />Occupant Load <br />Spri.nklers Required <br />CITY OF CVERETT <br />APPROVED FOR 13�11LDING PERMIi <br />Date�t��—Dy � r, _ <br />APPRQVER (OR QUILDING pEf2MIT <br />b.itn _ <br />