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v <br />CITY OF EVERETT PERMIT NO._� <br />DEPARTMENT OF COMidUNITY DEVELOPMENT y <br />BUILDING PERMIT APPLICATION VALUATION J- <br />PERMIT FEE de <br />DATE // <br />ADDRESS OF CONSTRUCTION WORK Z //(O 711i UO U I/Z <br />LEGAL DESCRIPTION: LOT y _ �- BLOCK Dr•Q PLAT 061 <br />UNPLATTED DESCRIPTION <br />BUILDING DESCRIPTION: NEW ADDITION REMODEL <br />C'R REPAIR <br /># OF UNITS OCCUPANCY OR USE STORIES <br />IS THIS A CHANGE OF BUILDING OCCUPANCY: YES j� NO <br />AC) <br />CONTRACTOR OWNER H yr[ <br />MAILING MAILING ADDRESS ADDRE-S �7 `[� 7%I� e)U 1;a- c� <br />PHONE NUMBER <br />CONTRACTOR'S LICENSE NUMBER <br />SIGNATURE <br />PHONE NUMBER 4,5',;29 <br />NOTE: THE APPLICANT SHALL FILL IN ALL ABOVE BLANKS COMPLETELY INCLUDING <br />THE PLOT PLAN SKETCH ON REAR OF THIS SHEET. THE APPLICANT IS RESPONSIBLE <br />FOR ALL INFORMATION WHICH IS FURNISHED ON THE APPLICATION. ANY CHANGES <br />IN THE INFORMATION, PLOT PLAN OR BUILDING PLANS SHALL BE SUBMITTED 0 `PHE <br />INSPECTION DIVISION FOR APPROVAL BEFORE PROCEEDING WITH THE CO. T CTION <br />WORK. <br />APPROVAL: / ,,v <br />1. PLANNING <br />2. ENGINEERING <br />TRAFFIC DIVISION <br />WATER SERVICE <br />SEWER SERVICE <br />PUBLIC SERVICE SECTION <br />INSPECTION 'ART PENT <br />4. FIRE MARSHAL <br />DATE <br />Z ^ %q <br />NOTE: ALL CONSTRUCTION WORK SHALL COMPLY WITH APPLICABLE CODES, NOTES <br />ON DRAWINGS, AND INSPECTIONS <br />k <br />TO f3 U/ 4- D 3 FR Ortq it/, f'k 0 f G I ,/rc, <br />