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� <br />BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form <br />/���� � <br />�/��� <br />If more than one building is to be constructed, submit a separate permit ap- <br />plication for each building. A separate permit will be isse,ed for each build- <br />ing. <br />� / / :� <br />Owner �.J/� ��_" C�"-h:i`:i 7: v�_' 7%�.�ri-'� <br />Address �� (�5�' . I;ii:{- <br />City E _l/t�t'r__:f ! Phone �-�,'l -t C, �,L <br />Architect • <br />City Phone <br />Contractar �H 1�� �c�N3S•iti�t!� %�c'rtJ <br />Address c���%pp� �/��_7f_ - <br />City�-._��.=rt�iJ- Phone2�?-11��1-4. <br />State License Number'"22�?�'-G�P-/3y-��� <br />Expitation Date 1 - �,'_'�-'% �, <br />I�`� <br />I D 5a��� r <br />. l��" <br />Pi�tJ - <br />� �" <br />I '�. 4- o = n" <br />I?ia�r�;ei�- �;`T; <br />��+�;� <br />i,? <br />Building nddress_ %���) /�h'i/�%�'.e' <br />Lot S % Blk. ('^c�f.� Sec. <br />Twp. L � Rge. ,i�J <br />Subdivision (Plat) /%`rc�'(.,;!�U- T /f.2'r,'r�r.'C �%� '�� <br />Metes & IIounds (Unplatted) <br />0 / <br />Building Use��;4;'�;Lr'"_ �r/-��i��- /-�-.cfF <br />Describe laork to Be <br />Use of Building <br />';�ew _ Addition .Repair/P.enodel <br />Valuation of Constructi,on $ � � i(�, <br />* , , ��r'„-�n.;pLOT PLAN <br />� ����-« T.�+II��i <br />Indicate lot size, name of streets, <br />__��J� � indicat-e locatiwi and tvidth of <br />�,� alleys, locate proposed and all <br />'..�, existing buil.din9s, show disCances <br />_�� I to proper*y lines, show 3istances <br />� between buildings. <br />I Lot size C�,C�•�O•,x -> � •, <br />� /�.0 - [J <br />i � Lot area ^TZ���� S.P. <br />' . � Sizc of Dldg. �'�,�i (.. S.F.. <br />`� Number of Stories � i <br />/� ,c', IIasement� ' �� {�, <,:� / _ <br />� Use 'l.au�—� � � � <br />NOT WRITG IIEIAlJ <br />Date Fieceived ��2C!'�7� <br />Plan Check Numbe � 75-/ 7s <br />Valuation '�, � �', � � , �=� <br />Permit I'oe %`?�3-'''�' <br />Plan Check Fee �uL.•�`�a <br />� Total Fee Duc / % cj . �Z� <br />Permit NumUer � <br />n � iss��a 41•�,i�� <br />� ,J <br />, —�— <br />�� ���'1��� �Lc--+ J�G 4'�%� � <br />Signed II� -{�`�/ �.-�"Y.7��� _i".. '- <br />:, <br />FOr � �I�.1`�C �_!"JI���_ i I��.l%. '� 1('�h�� <br />Otuner <br />Fire 7.one �j <br />Typc of Construction v - /�( <br />Occupancy Group ,r <br />Occupant Load <br />Sprinklers <br />CITY OF EVERETT <br />APPROVED FOR BUILDING PERMIT <br />Date .__ _ By <br />APPROVED FOR BUILDING PCRMIT <br />D.itn _ <br />