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� _ _ _. --« ... <br /> j J ; <br /> HUILDING PERM�iT APPLICATION � ���o� "��j <br /> Applicant To Complete Tliis ^orm � <br /> . . /;.'�.: f"7.,, <br /> If more than one building is to be contiucted, submit a separate permit applica- � <br /> tion for each b�ilding. A separate permit will be issued for each building. <br /> Owner �i�G� � fi �o . �l,�i !r,,�« Building Address Z c� i 5— C-'.= �r'� <br /> � � <br /> Address l� z / G t,� . , � Lot Block <br /> City /�o�r��` __ Phone 3SG 3v/i Subdivision (Plat) <br /> 1lrchitect/Enqineer �nT (�� /�,���+.�f../<., <br /> City �L•.•.�,c,,. Phone ? s".3 - �sv i-- Metes & Bounds (Unplatted) <br /> Contractor /tc,�/ (� l.. J` ��- 1.� Sec. Twp. Rge <br /> Address � v /r. 9.f-J' <br /> s <br /> City L- �:.r ?� Phone .�s"y -yi r`/ S3uilding Use �`i%-i� � " <br /> ; <br /> State License Number ,��. 3 - �i - '/.�'�z Describe Work to Be Done <br /> Expiration oate � /)[- T '. �'• �` / ° �," l, e /`` ' <br /> SICETCH PLOT PLAN BELOI4 ' � � r <br /> Dse of Building <br /> , ❑New ❑ Addition dd'RePair/Remodel <br /> - ' ' Valuation of Construction $ /U, non <br /> � . . PLOT PLAN REQUZREIdENTS <br /> • IIId1CdtE lOt SiZe� nd[11e oT StIe2t5. <br /> indicate location and width oi <br /> alleys, locate proposed and all <br /> existing buildings„show distances <br /> � �� . to property lines, show distances <br /> between buildings. <br /> Lot size x <br /> � Lot area Sq. Ft. I <br /> . Size of Bldg. Sq. Ft. I <br /> Number of Sto�ies <br /> . Basenent <br /> . > ' �i I <br /> Signed By ��L ,��%� _ ,,C'�t' i <br /> For i�� � //r l� � � <br /> Owner Phone : s�v - Yi T,� i <br /> i <br /> DO NOT W2ITfi 6ELOW THIS LINE-FOR CITY ❑SE OC7LY ! <br /> Da:e "�ceive� 1��'l\' _ U�e Zone �- � ' <br /> 1-..� .f� / I <br /> Plar. Check Vurbcr 75-4�� Fire Zone . � <br /> Valuation ? � ��f, _f���� _ Occuoancy Group F" - ? <br /> Pemit Fee �j��.. '��� Type of Construction �- i H-��� . <br /> Plan Checl: Fee � �J7J• �b Oceupant Load I <br /> Total Fee Due � � � , �� Sprinklers Required <br /> CI7Y OF EVERETT ( <br /> Datc Issucd �,�� I qpPROVED FOR f3UILDING PERNiI � I <br /> Daie i a /�i i /'1� By—L�—c_-_ — � <br /> � �- �� t-.,-; .� - r - ..�_ � ����_ ,. �. .- . I <br /> ;,_ . <br />