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<br /> __ . $DILDIt7G PERMIT A4PLICAT?ON 7 � �
<br /> - � . . , 1lpplicant To Complete This Sorm / �j � ��
<br /> • If more than one building is Co be contructed, submit a separate permit applica- 7�j
<br /> • . tion for each building. .1 separate permit will t:e issued for each building. J�
<br /> . „ / �j
<br /> � Ovner =iPi�„� � . c� �-,���Yl% Buildinc� Address %� •' // 1f•,�.�,, ,/" -
<br /> , . l�ddress 3 i 7 i ,�.�- Lot;i ��- � ry Block `7;-;5�
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<br /> Cit C �'� r��' L!:�-t/Phone '„-� � '
<br /> , y _ '� � S"�!� SubdiLision (Plat) i-;;.F� ,- % ,-,;.,;,�L"�
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<br /> ; Erchitect/Engineer �-;,�,y � .t , ��,f;;:"� - � �
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<br /> _ .�� City _/�"(,- ��„i,.�,//� Phor.e ��,"•>-i!'7i� Metes 6 Bounds (Unplatted) �
<br /> , - � —,
<br /> . �- :, ConCractor '��-� ��� � Sec.�_ 1tap. Rge �
<br /> _. . . Eddress - . � - ' ' •
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<br /> �! City - Phone � Buildir.g Use �%c�� � ������•=-C ".'e--1 .
<br /> , • - .
<br /> � � '" - State License Nct�her Describe Work to He Done � �� '�
<br /> • .; 1
<br /> �1 Expization Dat� '
<br /> '� � � SRETCH �LOT P?,:,?I BELOi9� •
<br /> - • - � ' . � .-, .
<br /> � ' Ose of Build�r. � � "
<br /> . : j . . . . . . . . 4 - 4 7�r_„ .✓_'.rCP
<br /> _t ; � � . _� . , _ . i . . �New ❑ Addition ❑ Repair/Remo�el
<br /> . �� ' � � � . � � Baluation of Construction $ ��
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<br /> -r..� ' - �. --� . • ^ PIAT PI.P.N REQUI�}f�:7T5 -
<br /> - . � Ga� PRo,�iiT - '
<br /> � -;���'�-,�� 2� i �:�i nn� � IAdicate lot size, nar..e of streets, .
<br /> � ��M ��-- f�—T. �£ndicate locat:on aad wi�th o=
<br /> � _ � . - . . : tV alley�, locate nroposec and all �
<br /> . � �'�' . _ existing buildi:ys, sho:o distances
<br /> . � . ; tI ' . . � -' -- •a ; . � . '_ '' . to propertp lines, show distances
<br /> � ' • between buildinys.
<br /> , . .. Lot si.ze _ ,`)� � x / � v� .
<br /> ..-- ` ' . . Lot area ,;: ��-�_ Sq. Ft.
<br /> .. - -. F�, Size oL Bldg. /�� :� ) Sa. Ft.
<br /> ` � � � Numbcr of Stories „ � ;.:
<br /> . ' , . �� � ' Dasement �y .`���
<br /> :.. • �. .� � . �
<br /> ,� •: '_ r, Signed By .-�� .,y_. �' � �.; ,..
<br /> � . �
<br /> � . For
<br /> 'f� �.�-t�, �i:>�,���j=�� Owner Phone � - - - G `,�'� G
<br /> � DO :70': Si:i?TL 3-LOC7 SHIS LINE-POR CIT'_' DSE Oi7L'L
<br /> Date r�ceived j�� Uce 2onc �"- I �
<br /> ' Plan Chec;; :7ur..ber ' �'' Z•�Q9 � Fire Zonc '�"�" ✓� '
<br /> �-y '-7—
<br /> Valuation �Y JLF�� � Occuoancy Grou� L �
<br /> Qc �r�
<br /> Pemit Fee J 6 • Type of Construction � � y�.
<br /> //�� ���. ,
<br /> Plan Check Fcc Y'y- E-� Occupant Load
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<br /> Total Fee Due ��jZ ��- _ Spr3nklerc Required
<br /> Datc Issucd 7 Z Z J` " ' CITY OF FVERETT
<br /> . . • APPROVEJ FOR BUILDING PE�hiff'
<br /> • Date 7-��'-,�-� �.. �;r h ('
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