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BUILDING PERMST APPLICF�TION <br />Applicant To Complete This Form <br />i <br />/ io 9�' <br />y�7��7r <br />Ii mare than one building is to be constructed, submit a separate permit ap- <br />plica�ion for each building. A separate permit will be issued for each build- <br />ing. <br />Owner �,'r %� �' . <br />nddress��' 'l'�)L�liJL> .) l i <br />City �i �r ��; _ Phone �/y, /y ,�-� <br />Architect • <br />City Phone <br />Building nddress�•� ��' �,. tiL- <br />Lot �� IIlk. Sec. <br />Twp. Rge. <br />Subdivision (Plat) �,�� (�� y� � >% <br />� <br />h]etes s IIounds (Unplatted) <br />Contractor [s�2it,y��it>>�rtc'lt�er - <br />nddress /D.�l:i /.5 %, ��/T' .S�'� � <br />/� n � � <br />City+ j"�Y��GZ � — phone ���, "! ` � U��L/ Building Use ��DE.c.%: i/_� c. <br />GS - � `l.bEx�7Fi "" I =� <br />State License Number� � j'C�� ��J rY � Describe WorY, to IIe Done <br />Eapiration DateJ � / f.h �fy�c1/pi � i U N� �� � JL-EC..S, <br />Fla� <br />�'G:!in�" D�.:o I __�..Jc i :—'_' <br />f.._._. <br />1..�,�rd �-:r. <br />.. �° _p,...., � <br />� °^..."_�.�.__..._ _� <br />, , - --.r _ . ...._ <br />.. � __, � <br />� � :. � I - �, -- <br />- <br />' 3 .� e.<�; i . � -� - -i .. _—_.__ <br />Plcn Chcd< P:o �S'� (D � <br />�������.� D <br />2 75 � <br />•.`�...� <br />:_ � .................. <br />CITY OF EV[RETT <br />Engineering Dept. <br />DO NOT <br />�� Jse of Auilding � <br />'� New -. Additi.on - Repair/Re�siei� <br />� Valuation of Constructi,on $.�rJ- 1�,,��- <br />TIiIS <br />Date Received ��%�= 75� <br />P:lan Check Number 7 S-( L, �� <br />Valuation �.�co S�(p.f2� <br />Permit Fee 3 l'o. p O <br />Plan Check F'ee <br />Total Pee Uue �Co• � " <br />Permit Numbcr� � c �� �f �'j <br />Date Issuad "f�/Z4- 7t� <br />'—i— <br />PLOT PLAN <br />Indicate lot size, name of streets, <br />indicaCe location znd t•:idth of <br />alleys, locate pr000sed and all <br />existing buildin9s, show distances <br />to property lines, show i3istances <br />between buildings. <br />Lot size x <br />� �Lot arca S,r, <br />� Size of Blcig. S.F. <br />Number.of Stories <br />IIasement <br />Use Zone , <br />� <br />Signed HY r- � ���`-�' �..'5�12' ' <br />ror ��c �y/,-�i_ �%�. 4� .st.��it ; <br />Owner � <br />USL' ONLY <br />Pire zone � 3 <br />Type of Construction <br />Occupancy Group <br />Occupant I.oad <br />Sprinklcrs Required <br />APPROVED FOR QUILDING PERMIT <br />n., i„ <br />