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p . . _ __..... <br /> . .L <br /> CITY OI' �VERETT PERMIT NO. 0 d / o <br /> DEPAP.TMENT OP COMMUNITY DEVELOPMGNT �/5� <br /> BUILDING P�T2t4I'P APPLIC.�TION VALUATION �t�c��J- r7�'i <br /> 7 . ;��� <br /> PERMIT FEE �`�`�� �� <br /> PATE L- '-I,-�� /'�' <br /> �� <br /> : <br /> ADDRESS OF CONSTRUCTION WORR /d'✓'`� ,=�` �"'f'� ' , <br /> �_ .�., ' BLOCK '<',�{> PLAT�%A�" L-_°"�<'_='%;�li�� <br /> LEGAL DESCRIPTION: LOT / , / .��- /r� ` <br /> • UNPLATTED DESCRIPTION <br /> ; <br /> , <br /> REMODEL ��- <br /> BUILDING DESCRIPTION: NEi9 �D12�I�N OR REPAIR _ <br /> $ OF UNITS OCCUPANCY OR USE �t, '��4't�= STORIES I . <br /> IS THIS A CHANGE OF BUILDING OCCUPANCY: Y�S I, NO <br /> /_. , � ,/ � —� <br /> / OWNER /�//r' �t�'=i f':' /i� y�"^'u-r4 <br /> CONTRACTOR v� //>'%�=' ( �F.''=i. `��� IdAILING <br /> MA:LING <br /> P:DDRESS �''>(li� \ Tf/�'- �-�i ADDRESS �/��O1���/�/f�`i'i�%� <br /> c 9' � � �/iEi'✓-'%i j�'7C % <br /> , ; -„f�i lG��ti �: � �r��i <br /> PHONE NUMBER �'_�=. �-- �/S,� Z- � PHONE NUMBER ! '� % -7 -/ '; .- <br /> , ; ._•�, � ... ��, ��.rJ <br /> �ONTRACTOR'S LICENSE NUMBER - �Z<- <br /> `f /j� <br /> �IGNATDRE � � � i� ' ^ � � -� <br /> NOTE: THE APPLICANT SHALL FILL IN AI,L ABOVE BLANKS COMPLETELY INCLUDING <br /> ' THE PLOT PLAN SI:ETCH ON REAR OI' THIS SI3E�T. THE APPLICANT IS RESPONSIBLE <br /> FOR ALL IN�ORM,ATION [4HICH IS FURNISHED ON THE APPLICATION. ANY CHANG�S <br /> IN Tti� INEOP.Ni.�TSON, PLOT PLAN OR BUILDING PLANS SHALL B� SUBMITT�D TO THE <br /> ZNSPECTION DI`IISIOIQ FOR APPROVAL BEFORE PROCE�DING i4ITH THE CONSTRUCTION <br /> WORK. . <br /> APFROVAL: <br /> 1. PLANNING DATE — <br /> 2, ENGINEERING <br /> TRP.FFIC DIV�SION <br /> Y7ATER SERVICE _ <br /> SEWER SERVIC:E ----'— <br /> PIIIILIC SERV�CE SECTION _�_ <br /> 3a INSPECTION FPARTMENT <br /> �L A., �ol���.�,�-- r / '�l �i <br /> 4. FIRE MF1RSIiAL <br /> NOTfi: ALL CONSTRUCTION S90RK SFIALL COb1PLY WITH APPLICABLE CODES, NOTES <br /> ON DRA[4INGS, ANn INSP�CTIONS <br />