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' 902LDING PERHIT APPLICATION ' ;'�
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<br />r ' " � ' � Rpplicant To Completc This :orm � `j �% �%? � ' • • ; .y •
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<br />•• '�Il more than one buildinq is to be contructed, submit a epar�te permit applica- j
<br />� .•� tion for each 6uildinq. �1 separate permit will bc issued for �ach buildinq.
<br />. , � ��r � /��.� 7 v�� _�r . �� Buildinq Address �%33 Gi,ra nd A ✓e . .
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<br />, • , 3Edresa _ � ��Z �'cc�J�r_r Lot !� <' �' � i Dlock % 3 ' f
<br />, Clty �� phone,� �;Z - i�"l'>.2 Subdi�ision (Plat) :
<br />_ � • �seIIilect/Enqineer � • �`l'���.�/ ���/� • . � .
<br />_ ' �',! : . .`.'1 . Citp • phone Hetes i IIounds (Unplatted) ' .
<br />:., . . �� Contractor �r�T=� �� �-...,,,Sec. '1Wp. Rge '
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<br />�. %• :'• ]lddress �9 ?3 /?c--��%�ti�-C.</ . �
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<br />� G-'%:. �
<br />• �f City �y�.-�?� Fhoneyt,�r /o2G�' Huilding Use �,���.� ��i �
<br />� �"" ., .
<br />4� . ��:.• • - . . .
<br />� State License Number `�►'�
<br />' ��� . ,2i2 �- t3 �� i� tl �' � Describe Work to Be Done
<br />� ; :.:I L?piration Dat� • ' • � `
<br />�.�' '� , • SICETC}I PLOT PLA!i BELO[Z' • '
<br />,' : � . � ' . . . . • .. • Dse of Buildirig
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<br />t ~ j � • , ' ' : � , • �]Nerr ❑ Addition ❑ Repair/Remo::el
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<br />� �• . " . � • j' • Valuation of Construction 5 ' �
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<br />�, • !. " . • : . .. , - ' • . . PZOT PLAN REQUIT_tESfE:7TS . .: .
<br />� . , � • ' =..
<br />;• ! • • ' ' . , ' � ' • ' ' Indicate lot size, nane of streets, �
<br />- • ''' " � '` ' - •iadicate location an@ width o�
<br />• • � ' ' _ � � � � - .. _ • alieys, locate proposed ar.d all � '
<br />• ' �' . ' .� ' �' ' • existin buildin
<br />. � � ' ..:^, : _. .. ,. : ' • . �..... • . . g 4s. sho:a distances
<br />, ,. t0 property lines, show distances
<br />,. � �.: ' : � , ' , • , betaeen buildings. .
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<br />y . ; •� • ' ' • � . : Lot size S�o x '/ � d
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<br />.r• :, i- .
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<br />DO :IOT {i:i?TT' DE :OFI
<br />• , . Lot area Sq. Ft.
<br />Sizc of IIldq. ;-; y� y�2 Sa. Ft.
<br />' Number of Stories ��,,,�r�
<br />' : , Basement !��-, �.,,,�
<br />Si9ned By //��-s.,.,'2 / �.,��
<br />. . z ,
<br />For
<br />• Owner Phone '� - ��
<br />a
<br />• : _ Date Seceived ��ZZ�T`� � � Oce• Zone �/�-� S/,t�t� �M�, �
<br />' Plan C:zec:: :Jur..ber 75= 7�� / ' Fire 2onc �3 '
<br />• Valaation Z��D•J, � Occuoancy Group _ 1
<br />Petait Fee ���• �� 'iS�pe of Construction �� - t�l
<br />. . . . , �Q .
<br />Plan Check Fee �O �•
<br />� lbtal Fee Due
<br />Datc Issucd ' '
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<br />Occupant Load -
<br />Sptinklcrs Requlred " '
<br />• • : CITY �l� EVERETT
<br />• ';' AFFRO`'JL-D, E',OR'3U.ICDING PERMIT
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<br />, Date �'-.� .?..'�. .BY--��._
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