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� -- � - - - --�- _ _. . _ __, _ �.9�y� ,� <br /> --- � --- --- � . . ,..1 <br /> BUILDING PERMIT APPLICATION <br /> • ^ 1lpplicant To Complete This ?orm �/ 3 <br /> / �� <br /> If more than one building is to be contructed, submit a separate permit applica- <br /> tion for each buildinq. A separate pezmit will be issued for each building. <br /> Ovner /�,�_fz K-S�,r_ �'r r/r.^n .�7 ofl Buildinq Address /,t �o //c..-.73� �uc_ <br /> 1laaress /z�o /J w„n' 9ac Lot '�G 3 .Q slocx (� � 9 <br /> City �i�e-e7Y"' Phone ,25 A-//:S/ Subdivision (Plat) %�.�,�cf�' ' <br /> 1lrchitect/Enqineer � <br /> City Phone Metes s Bounds (Unplatted) <br /> Contractor .�/l��w l,� )f' <.. I� Sec. Twp. Rge <br /> 7lddress /? o. Br.� 9S� � <br /> City `«,-e�y'- Phone ots�y- 9/9i Huildinq Use i i��/c t�� .�h..�/��.<���,;.., '� <br /> State License Number oZx3-o/- �/Yax Describe Work to He Done _ � <br /> Bxp3ration Date T�y /yJ6 � ���^>=�^ 1+'• � � <br /> SRETCH PLOT PLAN BELOW . <br /> Dse of Huilding �.+..c,--,./ _ <br /> � ❑New ❑ Addition Yd'Repair/Remodel <br /> ' Valuation of Con�truction $ 3 S�_ <br /> . • . . PLOT PLAN REQUIREMENTS � <br /> , . : <br /> Indicate lot size, name of streets, <br /> W � � indicate location and width of <br /> ° � alleys, locate proposed and all <br /> � '� � existing buildinqs, .show distances <br /> \� �� � . 3 to property lines, show distances <br /> ` \ between buildings. <br /> � Lot size x <br /> • Lot area Sq. Ft. � <br /> • Size of B g. Sq. Ft. : <br /> %" Number of Stories � <br /> ''�� Basenent � <br /> . . / � / /\ <br /> . Signed By /J � <br /> C-.-.�. �L ""��—, <br /> —�'l � For i <br /> Ownez Phone <br /> DO NOT WRITS BELOI9 THIS LINE-FOR CITY USE Ot1LY I <br /> Date '.eceived � � t)_e Zone _ <br /> Plan Check :Jumber �_�cl� Fire 2one ( • . <br /> Valuation 3�J���� eo Occuoancy Group Cs- k <br /> Perciit Fee �4-Z. �UC� Type of Construction V � t I-�12 , f <br /> O <br /> Plan Check Fee '�/Z �� Occupant Load � <br /> Total Fee Due Z�J4• 30 Sprinklers Required _ ` <br /> Date issucd �/�3 �7 �� CITY OF CVERETT <br /> APPROVED FOR BUILDING PERMIT <br /> Dafe�l �/,,L By K • C � <br />