Laserfiche WebLink
' , • • IIUZL"JING PP•.RMI'P APPLICATIOl4 . �-� �-7�`i. <br />_ • Applicant To Comp].etc '!`hi.s Por.m '�/J y t <br />s,�� �/i - <br />Tf more than one bui.ldi.ng i.^,'to be con�truc�cd, suUrnit a separ.��ie ��er.mit <br />app]ic�L•ion for each building. A �ep�irate per.miL wi.11 be issucd for each <br />building. v ' f � / � <br />O4mer � �, :_,•�� ���`3�`��G-`''• IIu•ilding P�ddress 1p �/,Zv-J�>:�.yc�---r�' <br />� • , ' (' y , <br />Addr.ess �"„ r.f .1-,,. _.. -.�i�-•c'_. . iot�a,,',-'-' - `13iocl: �o'�iA-n,. <br />City ' • , � Phone _�r��'j;�� Subdiyision (Plat) �:,, ,,,, <br />hrchi�ect P•.n ineer '�� 1c�`i� . <br />/ 4 �' r��i-�t. 1:,. <br />City � ,.o.s. ' Yhone �, � �'- ;- 1 ..�o� I�iet-e� tr T3ounds (llnpla i-tcd ) <br />Contxact-or .,ti•_� Sec. Tr:p. Rqc. <br />Rddr..;s ��,>.��'��-� „ „-,/1 <br />Cit l'" f% Phone ' ;' � • . . , <br />Y f n� • �.,_�- -, <br />State License Number 7�.�. �' -�^v / - '_�.'_ • <br />Er.piration Date <br />C07•PTW PiOP PLA1d ON RETTr,?iSE SID^ <br />Building Usc: �EI��4,(� �— <br />Describe S9cr1: to�e �_t,!;� <br />,_ . <br />.2 r iti � � ia: �..; .�, �=;' ✓�,_r /' � .f <br />_ ' ,;� (1 " i. <br />1;�n , s.� <br />Number oi Stories i <br />Basement� �(/�y � �-C'� <br />. ' " �er� Addition Repai.r./Itemodel' <br />Valuation of Con�t�uction $ 3'%;�; :>Y <br />Signed IIy _"l r....,., ; _.. <br />. . For �' � � ; � ��, <br />� Oi•7ner • Phone ��, 5���,-� y r-'. <br />Date Received � f 7C,o . '_;_ <br />Is7.an C�ecl: Number 7Co- /91t: • <br />valuation '�%3l0- �J • • <br />Pernit I'ee "%•� •�L <br />Plan Check Fee � y <br />'�otal I'ee Due � `Z. - �� <br />Datc Sssued ��� � � • <br />0 <br />is Line -For. City Usc On.ly <br />� Use Sone �- � � <br />I'irr. 2one �� 3 <br />Occupancy•Group _ -.I <br />Type oi Con �tr.uction �j - ti� <br />Occupant Load _ <br />Sprinlcicrs Requii:ed <br />' CITY OF EVERGTT <br />� � APPRO`JED �OR RUILDING PERMIT <br />hAte �%>—�`'__—!3y �""�"<:_„��--`� <br />