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BUILDING PERMIT APPLICATION <br />Applicant To Complete This ?orm <br />If more than one building is to be contructed, submit a separate permit applica- <br />tion for each building. A separate permit will be issued for each building. <br />Owner 1 kFr- 2/ /"OO �r Building Address CID.�-FY!'.v'1*y.(41, 1 <br />� ' u <br />�'RVLot _Hlack <br />--Address�F1,A/ �i <br />G � e <br />City f VF V Y %% Phone 35's— 9 10 1- Subdivision (Plat) <br />Architect/Engineer ZI n e7� V, <br />City Phone <br />"Contractor R)t SrA D I <br />'Address Ft7 130)( 3� ^� <br />�City4jogeli kjPhone4'0ytkl9?_t <br />State License Number 2.7 331 -n ! <br />Expiration Date p -' / " / <br />SKETCH PLOT PLAN BELOW <br />• <br />Metes & Bounds (Unplatted) <br />Sec. ��_ Twp•_,�-F RQe =f <br />Building Use <br />'Describe Wcrk to Be Done _ <br />, <br />Use of Building <br />❑New [I Addition ❑ Repair/Remodel <br />Valuation of Construction <br />PLAT PLAN REQUIREMENTS <br />Indicate lot.size, name of streets, <br />indicate location and width of <br />alleys, locate proposed and all <br />existing buildings, show distances <br />to property lines, show distances <br />between buildings. <br />Lot size x <br />Lot area Sq. Ft. <br />Size of Bldg. Sq. Ft. <br />Number of Stories <br />Basement � <br />'Signed By ,L•—"-`-= •� /-X.eAr <br />--For 71, <br />Owner Phone 75 <br />DO NOT WRITE BELOW THIS LINE -FOR CITY USE ONLY _ <br />Dnte .:_eised <br />Plan Check `7ur.`er <br />Valuation <br />Permit Fee <br />Plan Check Fee _ <br />Total Fee Due _ <br />Date Issued <br />U e Zone <br />Fire Zone <br />Occupancy Group <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />CITY OF' EVERETT <br />APPROVED FOR BUILDING PERMIT � <br />Date � /e : �� BY � �a - �- <br />