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- ., ( . . . • . DOZLDING PERMIT APPLICATION , , // :•. /'/ .� :�.t •.
<br />Z • applicant To Complete This Form �/� �'�'1 �� ��
<br />„ ; . . , '� .�/1��5� .
<br />', ,• If ewre than one buildinq is to he contructed, submit a separate permit applica-
<br />' tSOn for eac;h buildinq. �l separate permit will be issued for each buildinq.
<br />� ; � OvaGt c� A �� �1�@ S fC � Buildinq Address � ; �i��( �� / �i_ •
<br />.
<br />'. j 3deress 3'3 %'1 EtGo� n.in�.!_ Lot Block '
<br />• � C�tY �U���'�TT phone,� L � �'.��,� 3ubdivision (Plat) •
<br />• ' � N �_3,(� E .� a � � .
<br />_ ' � � irchitect/Engineer � " �� � Qy Q ,, ,, � sr�t.a__ • •
<br />_•:���.,°c'; City • Phone tletes 6 Hou� ds (Unplatted) '_
<br />_ ,.i . .
<br />;,• Coatractor ' � Sec. T�+p.� Rge '
<br />. . •, . . .
<br />¢. ' � ..i• '. • . -
<br />.;•.. lddress •
<br />".�- --� ►
<br />.1; City Phone Huilding Use � ���.;p,tia�Q��;.',.;;._
<br />~�'{� � State License N�er � Describe Work to Be Done `�+''.�
<br />Y
<br />. . . ,. . � , ������� :�.
<br />• • ' ;I . L�tpiration DatB ' • J/ � e•7e4 ,
<br />��' 'yi , � � SiCETCEi PLOT PLAN BELOW� • � �-�/�� �
<br />.' • : j , .: ' • . IIse of Buildinq _ :
<br />►. , ._�= ' ' ` ' � • DNew � Addition Q Repair/RemoGel
<br />, . .. •.t' . . � ' . ..
<br />' ' ' � �°' � � • Valnation of Construction $ .2 J G • C.'t-- •
<br />. { . _ ,
<br />.._. � � � . � - . , . •. PLOT PLAN REQUIR&`SENTS _ .
<br />.�, . . �t, � . � . . , � .
<br />� . . �
<br />','j , �y�T . • � . .. Indicate lot size, name of streets, .
<br />� � �i • ' + . • •indicate location and width of
<br />• •� " 1: •�� .= , e s locate nr000sed and all �
<br />,. _ �• ally. . .
<br />.. ' �'� .1'' existing buildiags, show distances
<br />; � ' c••� � • � - '.'� . ' to property lines, show distances
<br />�, •�1' � �^ b¢taeen buildings. �
<br />, �j .
<br />� I''.' • . • ' �
<br />• i,ot size r'i' x.� 0l7
<br />a •
<br />�. ..i- � 1 J � Lot arca <Q [ /J /f Sq. Ft.
<br />: '= C� •'. Size of Bldg. Sq. Ft.
<br />�i , ' � , Diumber of Stories
<br />:. . , � . �asement
<br />.:..
<br />'r'-.. • . r ' '`. Signed By
<br />; :��' �-- ' . .
<br />• • . '� x � %•�a . .�,y�, E�1c�ti' 8or
<br />, . �� ��� ��✓� � /�iV� , Owner Phone .
<br />� ✓ ' •
<br />/pC4 ff
<br />� � � uD0 N,�S ZHT� HELOtl THIS LI:IE-cOR CITY USE O2tL'l .
<br />-- — Date received � Dee Zone
<br />' Plaa• Cyec:: :7ur.ber ' Fire 2onc "
<br />Valuation Occunancy Grou� �
<br />Pemit Fee Type of Construction '•
<br />. ' 'Plan Check Fec Occupant' Load •
<br />,,� 1b[al Fce Due ' Sprinklers Required �
<br />' � . Date Issucd' ' • • �. . •• ' .,�ITY.OF•.[VERETT • . •
<br />• . ,•< t , � APP.ROV�D:.t•ciR Gl1iLDING P�RMIT : �
<br />' .. � . ' . : •' � • ' . ,00tc�'��� 'Qy�� �t _. . . �
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