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<br /> � � : � ' DOILDING PERMIT APPLICATION � � �
<br /> _. , j }.3'�,�.:: i
<br /> • � ' , , Applicant To Complete This :orm �;i
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<br /> , • � It more than one buildinq is co b� contructed, ;;ubmit a separate permit applica-
<br /> . , tion for each buildinq. el separate permit will be issued for each building.
<br /> . ' ' Ovaer �c'��nim P�n ns 6,., r-;..J Buildinq Address ��,>�ar
<br /> . � , Mdress 3ic � o�ii<ct Lot �6 J'i3o Block 7`�0 •
<br /> City c����irrr Phone .�sY-cio-� Subdivision (Plat) �.;� ,— .,� �v.•�c�i • '
<br /> � • Architect/Enqineer �
<br /> _ • s '"� City Phone Netes L Bounds (Uuplatted)
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<br /> . :, Contraetor T'c D kt ut,�i Lc.J ��... e� Sec. •7 y 7Vp. :S Rge 2 - � �
<br /> , � 1lddress 6819 O(�vwPi� 'lc��� . • •
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<br /> , C3tp _estir�r.*r PhOnO 1:�3-tSl.c; BU31d1nq Use L.+�..-� c(���ic i:•j,_�'..
<br /> � � �;i � State,License Number �J�3 �c�- i1'31; Describe Work to Be �one ��,�.� �u est,�'�rt ��,�
<br /> � : - �I Lzpiration DatB �� 6 i571, � IN n,�1��� -r,, c�.�.,..9t6cr �5�cc
<br /> .1 : � � � . SICETCH PLOT PLAN BELOW' • A,Crr+ AP%'��-c�R � � X �`� � -
<br /> ' :.j ` � �� � Qae of Building ,CAw c�, i� '
<br /> ► _ . .� �• , . � �New Q Addition ❑ Repair/Remo;Zel
<br /> � ' ' � 3� ' 'Valuation of r.onstruction $ -���:� ' �
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<br /> ��`•:. �� � ' Ya . . �' , PIAT PLAN REQUIRE}IENTS , .
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<br /> ' ; � ' Indicate lot size, nane of streets,
<br /> � !U • indicate location and width o=
<br /> . � 3% � • • �,�[�z alleys, locate proposed and all
<br /> `''1.� � Pacisting buildings, show distances
<br /> . . i s� ' " '- `! : . ' . to property lines, show distances
<br /> � w`! , _j�_ between buildings.
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<br /> � �y . � } � Lot size (;V 3> x '„
<br /> ••- ' . Lot area y�,�5 Sq. Ft.
<br /> - Q������� '� • Size of Bldq. ,';;� r, fo Sq. Ft.
<br /> ` � ���y n„� •a-' Number o5 Stories �
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<br /> • .. . � Basement �r c�
<br /> :.. �� '11
<br /> '. ' � � Signed BY \ -Jw.�- �r��..c 1.� .
<br /> �.: �t,�
<br /> • _ For
<br /> � Owner Fhone ,�:iy-o�c;
<br /> ' DO N0: IC3?TT' B:LOtI THI.i L2:7£-20R CITY USE Oi7L'L
<br /> . Date Received j p Uce� 2one
<br /> ' Plan C:�eck ::u.:.5er Fire Zone "
<br /> Valuation �ic.,�v� Occuoancy Grou�
<br /> , �,t� —
<br /> PemiE Fee Z G lype of Construction
<br /> Plan Check Fee Occupant Load
<br /> , 1bta1 Fee Due 2�� Sp=inklers Required
<br /> Date Issucd •— � � �
<br /> • . �. C17Y Of. EVERETT
<br /> ' ' � � `AppROVEn FOR BUILDING PEFMIT
<br /> • . .Date- >> gy I� . � - .
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