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Applicant To Ccmplete rnis :orm / Yff <br />If more than one buildinq is to be contructed, submit a separate permit applich- <br />tion for each building.IA/separate permit will be issued for each building. <br />�!y <br />xOwner �y� % - Building Address L�// �$%,b'�i`Y• <br />Address f34// 8 % ✓e, Z Lot Block <br />"2 3 '_ <br />� / G <br />City Phone1V,Subd}v:ar )o��' f r /r�'•a/L% <br />Architect/Engineer <br />City / Phone / Metes 6 Bounds (Unplatted) <br />(.Contractor <br />/_ _. / ��! b Sec. _ '!wp• 2'i Rge <br />jI Address -JA 11, reae•- uV i <br />I City Phone <br />r 'State License Number 6`'a33 e/ //.3,73 <br />p. Expiration Date -Z.A Z 7� _ <br />SKETCH PLOT PLAN BELOW <br />Building Use . zee• - <br />Describe Work to Be Done <br />Use of Building <br />IgNew ❑ Addition ❑ Repair/Remodel <br />Valuation of Construction $ <br />PLOT 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 73.0 x /0a.0 <br />Lot area /0 6 Sq. Ft. <br />Size of Bldg . Sq. Ft. <br />Number of Stories <br />pasenent <br />,.,Signcd By <br />For <br />Owner Phone -, d 3-3-�/G <br />DO NOT WRITE BELOW THIS LINE -FOR CITY USE OtILY <br />O••e ._^i d J \ U:e Zone - — <br />Plan Check Nu-i•cr <br />Valuation <br />Permit Fee <br />Plan Check Fee <br />Fire Zone <br />occupancy Group <br />Type of Construction <br />occupant Load <br />Total Fee Due _ Sprinklers Required <br />aatc Issued CITY Or EVERETT AFFROVED rQr. CUIL `!G PERR"T <br />