Laserfiche WebLink
BUILDING PERIIIT APPLICATION • •-•ry9 •i " <br />! Applicant To Complete This :orm / T <br />It more than one building is to be contruc •d, submit a separate '� <br />s p permit applica- <br />Lion for each building. A separate permit will be issued for each building. <br />Omer Alonze Roby. Building Address '5121 Delaware <br />Address 5121 Delware St. <br />City L'verett <br />Phone 242-9303 <br />Architect/Engineer <br />_ .• <br />.._i <br />city <br />Phone <br />Contractor Lv�ro+t <br />Ri�;ldar pit, <br />Lddress _ 5606 Lvergreen 'rJay <br />Y <br />city Lber.ett <br />Phone 553•-7161 <br />•►1 <br />28 State License Number 223-01-11 <br />4 <br />.1 <br />Expiration Date <br />2-1-76. <br />SKETCH PLOT <br />PLM BELOW <br />_ <br />:.• <br />q <br />Lot , Block <br />Subdilblision (Plat) <br />Hates 6 Bounds (Unplatted)y <br />Scc. Tap. Rge • <br />Building Use :.� _L• <br />Describe Work to Be Done - }• <br />Fu't per <br />Use of Building <br />ElNew ❑ Addition Q Repair/RemoSel <br />'Valuation of construction $ 450.00 <br />PLOT PLAN REQU_M%=ITS <br />Indicate lot size, nano 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. Sa. Ft. <br />Number of Stories <br />Basement <br />Signcd By <br />For <br />Owner Phonc <br />DO NOT [•:RITE BLOW THIS LINE. -FOR CITY USE ONLY <br />Date Received U--e Zone <br />Plan Chec); !lumber <br />Valuation 450.00 <br />w <br />Permit Fee 'J, � <br />Plan Chec): Fee <br />aotal Fee Due <br />Date Issued <br />Fire Zone <br />Occupancy Group <br />Type of Construction <br />Occupant Load <br />Sprinklers Required _ <br />I <br />