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KOF EVERETT . rl <br />DEPARTMENT Or COMMUNITY DEVELOPMENT <br />BUILDIN& PER14IT APPLICATION <br />DATE � u f_-f 74 <br />ADDRESS OF CONSTRUCTION WORK ?- 50 <br />LEGAL DESCRIPTION: LOT U N BLOCK <br />UNPLATTED DESCRIPTION `mot C I I o N l `B - <br />BUILDING DESCRIPTION <br /># OF UNITS <br />NEW X ADDITION <br />OCCUPANCY OR USE <br />J <br />PERMIT NO. <br />VALUATION �a <br />PERMIT FEE �G•1° - <br />r�iZ.oADw/>�r <br />PLAT <br />REMODEL <br />OR REPAIR <br />STORIES <br />IS THIS A CHANGE OF BUILDING OCCUPANCY: YES NO <br />CONTRhCTOR CU`- iorGPAf=T T=0(-C I+yC • OWNER {-I ICI<o2Y Ff�,�M`j <br />MAILING MAILING <br />ADDRESS r •U, -RoK 2 F3'L ADDRESS _ <br />U'-f Ac L Ly P <br />uY �F45 7E591 <br />PHONE NUMBER Ysr=A) P,SZ %20ft <br />PHONE NUMBER <br />CONTRACTOR'S LICENNSSE NUMBER <br />n(/ Z2�> O SF�33 <br />SIGNATURE ��/ l�• /�.'J \y//�_ <br />NOTE: THE APPLICANT SHALL FILL IN ALL ABOVE BLANKS COMPLETELY INCLUDING <br />THE PLOT PLAN SKETCH ON REAR OF THIS SHEET. THE APPLICANT IS RESPONSIBLE <br />FOR ALL INFORMATION WHICH IS FURNISHED ON THE APPLICATION. ANY CHANGES <br />IN THE INFORMATION," PLOT PLAN OR BUILDING PLANS SHALL BE SUBMITTED TO THE <br />INSPECTION DIVISION FOR APPROVAL BEFORE PROCEEDING WITH THE CO[STRUCTION <br />WORK. > <br />APPROVAL: <br />1. PLANNING <br />2. ENGINEERING <br />TRAFFIC DIVISION <br />WATER SERVICE <br />SEWER SERVICE <br />PUBLIC SERVICE SECTION <br />?. LN/SP/EsCTIO TMZ, <br />4. FIRE MARSHAL <br />NOTE: ALL CONSTRUCTION WORK SHALL <br />ON DRAWINGS, AND INSPECTIONS <br />Mox N--r coSPT; Fz�3 <br />DATE <br />/ %d 07 S <br />ES, NOTES <br />P94wi9 �' <br />