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- � .-.:-, , <br /> __ � - : � � BOILDING PERMIT APPLICATION � / � ' � � <br /> � - :' , " . Applicant To Complete This Sorm � - � l ��� � <br /> . � <br /> , • • I! more than one buildinq is to be contructed, submit a separate permit applica- .,0/� <br /> . . tion for each buildinq. A separate permit will be issued for each building. � <br /> . Ovner � � � � �� ,�%u��AA �,.�� Huildinq Address L{�2 S �/Lc�p�. <br /> - . , !. .1 <br /> � , )Idaress �%?��✓T'iu�/�.n., 7�i� Lot slocx <br /> , City ���:1� Phone �" 51�0�Subdivision (Plat) : <br /> _ ' • luchitect/Enqineer � <br /> "'� City � Phone 2 �/D�j� <br /> - =j �.Z / Hetes S IIounds (Unplatted) <br /> , ,:, Contractor i' � / Sec. �p, gye • . <br /> :. L � . <br /> _ . ' �aICSu `J JD ' • , <br /> '!; City ..�� ,/�'/ Phone ,35 � $�2�� Suilding Use � ,�,�/j ..'_�.' <br /> - ��i � State,License Nur�ber 2Z��0�-� ��' �p Describe Work to Be Done � `�� <br /> . . - � _ ?r h��_a-,��� �.�... , <br /> • �I tScpiration Dat� �2 ��J � � <br /> _ ��: - � . • SRETCH PLOT PLAN BELOW� • - <br /> . ' I . — ' . <br /> :.i . . Dse of IIuilding ' <br /> -� ,. • � • , . �New ❑ Addition ��i2epair/Remo::el <br /> . . • � • 'Valuation of Construction $ZV �.—'� <br /> a _ <br /> �••..• � . . . • � . PIAT PLAN REQUIE2ElLNTS <br /> V . I <br /> � � " • ' Indicate lot size, name of streets, <br /> � ' ' 3ndicate locat:on and width of <br /> • � � _ . • alleys, locate oronosed and all <br /> � ��_� _ . . existing buildi.-,gs, sho:u distances ^ <br /> • �' '! . � - • to property lines, show distances <br /> � <br /> ' � � - between buildings. <br /> , . ' Lot size X <br /> "' ` � � , Lot area Sq. Ft. <br /> �� .. - • Size of Bldq. Sa. Ft. <br /> . ' � . � • Number o£ Stories <br /> '�: ,-' s • Basement � <br /> �� ` Sianed fly ��c <br /> �, /� , ' <br /> ' • . For GGG,G'�(�+-c,Q�� ✓rtzo�c6— <br /> _ T Ownei�� phone 35�-�.�5'x 8 2 <br /> � DO :70: R:7ZT5 BELO[9 THIS LI;Jt'-20R CITY JSE OiIL'! <br /> _ Dzte Seceived l /7i '�S� Uce� Zone R_ <br /> ' Plan Check "u.:.ber 7'S -2���j ' Fire Zanc 2. • <br /> Valua�ion � �i�Q� � Occuoancy Grou� �_� <br /> Pemit' Fee Type of Construction �/ - �.�. <br /> Plan Check Fee Occupant Load � � z <br /> : Tota1 Fec Due Sprinklcrs Required _ <br /> Datc Issued • ' ' ' . CII,Y OF EVERETT <br /> �. ' • , . ' APPROVEb FOR [3UILDIf�G PERMIT <br /> � • " Date � �' °-�;_'=---BY � � <br />