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i <br />CITY OF EVERETT <br />DEPARTMENT OF COMMUNITY DEVELOPMENT <br />BUILDING PERMIT APPLICATION <br />DATE / - 7 <br />15ip- <br />ADDRESS OF CONSTRUCTION WORT; r//P/Ja <br />LEGAL DESCRIPTION: LOT BLOCK <br />UNPLATTED DESCRIPTION <br />PERMIT NO. � r <br />VALUATION_ <br />PERMIT FEE (po. 3 0 <br />PLAT <br />SE <br />BUILDING DESCRIPTION: NEW ADDITION <br />C <br />OR REPAIR <br /># OF UNITS OCCUPANCY OR USE fq,/SAq,,STORIES S/A,c7�P <br />IS THIS A CHANGE OF BUILDING OCCUPANCY: <br />CONTRACTOR <br />MAILING <br />ADDRESS <br />i <br />PHONE NUMBER <br />CONTRACTOR'S <br />SIGNATURE <br />YES NO /` <br />OWNER H,4, S4V de eZe <br />MAILING <br />ADDRESS 5e&Wy;r.eS <br />,geX7; 1P <br />PHONE NUMBER Q %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 INFOR•L`-,TION h:HICH 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 CONSTRUCTION <br />WORK. <br />APPROVAL: <br />1. PLANNING <br />2. ENGINEERING <br />TRAFFIC DIVISION <br />WATER SERVICE <br />SEWER SERVICE <br />PUBLIC SERVICE SECTION <br />?. INSPE TION DEPARTMENT G� <br />4. FIRE MARSHAL <br />%7� <br />NOTE: ALL CONSTRUCTION WORK SHALL COMPLY WITH APPLICABLE CODES, NOTES <br />ON DRAWINGS, AND INSPECTIONS <br />