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<br />'' ' �� t ' . • ' ' , lOILDINC PEAMIT APPLICATIOtI , , �,• ' � _ i ��
<br />- ' " � - �pplicant To Complete This :orm ' •.� ��.�
<br />.. . i . • • ,
<br />, •' I! aore than one buildinq ie to be contructed, submit a seoarate permit applira- �
<br />.: tlon for eaah buildinq. �1 separate permit will be issued Eor each buildinq. /
<br />. .• Oraer �l9� �C� � i� /"k C/� u h�.-� Dnildin Addre�s � / � . 7S
<br />. � ufL.__ 4 ��/ZO YI tq�/c�,_.% (� i�
<br />'•, ldaress �i� �� � E�r � G�,.f � r i c� c Lot�_ S2ock �'
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<br />. C1tp l �. � � Phone� 5�- t/�(7/ Subdi4ision (Plai) ,li�+-77` ' •
<br />_ � ; �seIIitect/Enqineer _ �t �}��. Rt��!Qi ,� � � v-�ii�e,• . .
<br />_ •,'�• :. .`� Mtp Phone !(etes i eounds (Unplatted) •
<br />:.� . . , _
<br />:.': Oomtractor ���/i� ' Sec. SMp. Rqe .
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<br />: • ;, . , � �ddress S' . , •
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<br />.. �� Mtp Phone �ailding Ose � • :<'�•; :a� � .
<br />.,1t .: 'r: •' � � . � . . . .:ti•_'%r ..
<br />� j State License Nw¢ber Describe Work to Be Done �'�'�
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<br />: : 'i L3Pization Date ' flidt.�i/�// �i+o«, q�- � !r/��oti�
<br />�.�' • • S1�TCH PLOT PLAN BELO[i' • "
<br />. . .� • „ � ,
<br />Osa of Buildiriq
<br />�'' � i � • ' ' � � � , , „ ' Nerr L�I Addition ❑ Repair/Remo;:el
<br />. . . �.: � �' �.
<br />i . ' � � � .: � • • • Valnation o£ Construction $
<br />�, '�� I. , • .-.��t i${, I . P7.OT PLAN REQUITtE.HENTS ' .
<br />'' J ! � . ,t� � ,� • � j. • 'X
<br />• .' t ' ' ��l���y � G'��/i �ic-ti'' � %�,. ' Ii�dicate lot size, name of streets, �
<br />��� . ` � ,�J/ . , • ' •iadicate location and width of ,
<br />' ,, p}'�ji , ' - �, �.: -r • •T'� . alleys, locate pr000sed and all
<br />•-•'��. • . : . existing buildinqs, show distances
<br />/t`'1 •^�''" � '4': to property lines, show distances
<br />, t . ' � ' , • betveen buildinqs.
<br />: • • • . � .
<br />. . � oz.�0 , .
<br />. , .� .. -� �•• �. . . . ; ' ~ � riOt 6�Ze �X_ .
<br />� :•i- • � � • . . Lot azea —Ci
<br />_ Sq. Ft.
<br />• �. - • � Sise of 8 q. Sq. Ft.
<br />�t , • - Humber of Staries
<br />. • :: . � � . Sasement �i.�
<br />� r:.:�• ,
<br />• '_ � �t . Signed By
<br />_ � �S. . .
<br />. '_ . . Fo!
<br />� .' � pwnez Phone
<br />..' - � DO NOT SS:tITE H=LOt9 THIS LI3E-cOR CITY USS ONL'! � .
<br />_ _ Date Seceived � - Dt��Zone . '
<br />' Plan C1eck.:lur.Ser %�j"3iQ� ' Fire Zone 7 �
<br />Yalaation �� � Occuoancy Grou� T
<br />Petnit Fee 3�• �t%` Type of Construction Ti _ L
<br />Plan Check. Fee �� '� � Occupant Load •
<br />. � ibtal Fee Oae ' �� Sprinklers Required — ' .
<br />� " ' ,-,/. _-- • , . . ' CIT�' OF EVERETT �
<br />Date Issucd • � l�"— , AP;PROVED FOi2 BUILDING p[RMIT
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<br />. : , , . . . , Date'�-F--�� EX K �
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