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. .w. a q 9= �� <br />IiUILDING PPRMIT APPLIChTION <br />Applicant 'Po Com��lete Thi.s ror.m o?�v ��� ( <br />If more than one Uuilding is to be constr.ucted, submit a separate ner.mit <br />applic�ltiun f.or each building. A seParat-e permit wiil be issued Lo�: each <br />building. <br />Owner V IIuildin Addre�s j�p� i�Eli, �;`{, <br />�I (.�L- � E! �1�1 9 " f� vi <br />Address .'�i�� �!n DM'1C� Lot 2��_ II1oc}: ��� <br />City �11�.�f! I�hone dL �Z- �,��j � Subdivision (Plat) �. t'���E?t <br />' � I V <br />Architect/Engineer _ _ <br />City Phone Metes & IIounds (Unplatted) . <br />Contractor f11,JNE.�?_ �I��`� ����� �� Sec.__ Twp. Rge. <br />Acldress �'j A N �= <br />Cii:y Phone _ _ <br />State License Number - <br />Expiration Date <br />suilair,g vs� � F'��I l EN L E <br />Describe t�7or): to Be Done <br />��,p��,,(�:,Cr ��t_�'-� I���'�.��; [�.�Z= <br />Number oi Stories � _ <br />Basement �,� li <br />�Ne`� Addition Repair./Remodel' <br />/ <br />Valuation of Const�uction $ <br />+ (� �000�'�v-/� <br />Signed IIy �"G!h% �?i�P� n <br />ror __ <br />Owner Phone <br />S9rite Beloor This Line-For City Use On.l <br />Date Received �� 1s��7 � • <br />L�lan Check Number 7�" /� q <br />valuation 2'�OU • «' <br />Permit Fee <br />Plan Check Fee <br />Total Pee Due <br />Date Issued <br />Use Sone <br />Fir� Zone 3 <br />Occupancy Group Z <br />Type oi Construction � - 1�.1 • <br />Occupant Load <br />Sprinklers Required <br />CITY OF [VERETT <br />APPROVED FOR [iUiLDIitiG PERMIT <br />Date�� � / � gy i� .� �'�.—_._ <br />[' <br />