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BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form <br />If more than one building is to be contructed, submit a :separate permit applica- <br />tion foreachbuilding. 1A separate permit will be issued for each building. <br />Owner �y[(�11Q�" ��! /(a(��� Building Address 3507 019,rEc' <br />Address ,!U)0 ;' Lot �''�, J �G , Block <br />City t'd�icTT Phone.��_?-6,'3 _S Subdivision (Plat) <br />Architect/Engineer - <br />City Phone -- Metes a Bounds (Unplatted) <br />Contractor fig`«ITT r3U'i[/>E,t'S-J;1.'C Sec. <br />Address <br />City CrFIL-E7T- Phone " z- Building Use <br />State License Number ;y'2,'�3-p/-//l�z;Q Describe Work to Be Done <br />Expiration Date <br />SKETCH PLOT PLAN BELOW <br />Use of Building <br />TwP Rge <br />❑ New ❑ Addition ❑ Repair/Remodel <br />Valuation of Construction <br />• PLOT PLAN REQUIREMENTS <br />Indicate lot size, name of streets, <br />indicate location and width of <br />alleys, locate pr,;posed and all <br />existing "!Idi„gs,.show distances <br />.' <br />to property lines, show distances <br />between buildings. <br />Lot size x <br />Lot area Sq. rt. <br />Size of Bldg. Sq. Ft. <br />... <br />Number of Stories <br />-- <br />Basement — — <br />Signed By <br />For <br />Owner Phone <br />DO NOT SPRITE <br />BELOW THIS LINE -FOR CITY USE ONLY <br />Date ncceived <br />Ut.e Zone <br />Plan Check Number <br />Fire Zone <br />Valuation <br />Occupancy Group <br />Permit Fee <br />Type of Construction <br />Plan Check Fee <br />Occupant Load <br />Total Fee Due <br />Sprinklers Required <br />Date Issued <br />CITY OF EVERETT <br />APPROVED FOR L'UiLi G!G PERMIT <br />Date Dy <br />