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BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form <br />If mora than one building is to be contructed, submit a separate permit applica- <br />tion for each building. A separate permit will be issued for each building. <br />Owner } L SPO-QTWV boc)OS Building Address <br />Address 2-46 Z- ikO Y'r Lot Block. <br />City SQCM-eTr Phone2-131 Subdivision (Plat) <br />Architect/Engineer K�LEWIAND <br />,Oity 120gw-`cam Phone 2Sq-'I19 1 Metes 6 Bounds (Unplatted) <br />Contractor MCaW_tb%NIDc(]]CoU%T' C 0, Sec. Twp. Rge <br />Address �•0 �K 1�f7 <br />City —ZJ`' q Phoone2�,-�,1�► i Building Use C-0VAV rrV— A,,L 1 <br />State License Number I] I-�Zy9l - %('J Describe Work to Be Done _ <br />Expiration Date 0.-3C L— OFFIG�- �A�i�i�oNS <br />SKETCH PLOT PLAN BELOW —!� CR"'��` <br />a � <br />DO NOT WRITE BELOW <br />Date ^.cceived ij 119V7 <br />Plan Check Number -7 <br />Valuation Coo-�� <br />Permit Fee 2-0�� <br />Plan Check Fee 13/ <br />„u <br />Total Fee Due <br />Date Issued <br />Use of Building <br />❑ New ❑ Addition gRepair/Remodel <br />Valuation of Construction $;?00() 1 <br />-01 <br />PLOT PLAN REQUIREMENTS <br />Indicate lot size, name of streets, <br />indicate location and width of <br />alleys, locate proposed and all <br />existing buildings „show distances <br />to property lines, show distances <br />between buildings. <br />Lot size <br />Lot area Sq <br />Size of Bldg. Sq <br />Number of Stogies <br />Basement <br />Signed By <br />For <br />Ft. <br />Ft. <br />Owner Phone <br />i <br />IE-FOR CITY USE ONLY I <br />I <br />tl_e Zone <br />Fire Zone - <br />Occupancy Group- <br />Type of Construction <br />Occupant Load _ <br />Sprinklers Required <br />c,Tv (37 EVERETT <br />APPROVED FOR BUILDING PERMIT <br />Date Z �1�1 t�, By <br />