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BUILDING PERMIT APPLICATION � S S C� �I •••� <br />Applicar.t To Complete This ^orm �//C/��� <br />if more than one building is to bc contructed, submit a separate permii: applica- <br />tion for each 5uilding. �� separate permit �: L1 he issued for each buildinq. <br />pvner I-�. I-I �J-2�Zi=�-� Buildin9 Address � �_N /'farz� �vN <br />•�Z� T2p,�f �,� ('�, r.ot�_ sio�x � <br />Addiess a, <br />'�,� .y� Phone.>�3-9�-�'i Subdivision (Plat) /,t��wrcci���i✓• � <br />City 1= �'•z _-- <br />Architect/Engineer _�- <br />City <br />Phone �_ <br />Contractor � �. .Li__P ��--- <br />Metes 5 Bounds (Unplatted) <br />Sec. 7Wp. Rge <br />Address / <br />Cit Phone �_ Buildinq Dse s'PJ' '�0�-"77 �� <br />Y . <br />State License Number Describe Work to Be Done _ <br />�cJa // h ' <br />p� L� � f1.P.n s.. r <br />Expiration Date <br />SRETCH PLOT PLAN BELOW <br />Ose of Building � r�� <br />❑New ❑ Addition Repa' /Remodel <br />' ' Valuation of Construction S� U U�� � <br />,._� . :_�_•:�,e �-_/0' �S� <br />pLan ...`.ec% :7cr=-- — — <br />Valuation �Q�� <br />�p U <br />� <br />Yerc�it Fee <br />Plan Checi: Fee <br />�o <br />Total Fee �ue � <br />Da[c Issucd �/��'/�'� <br />PIAT PLAN REQUIREFIE:ITS <br />Indicate lot,size, name of streets, <br />indicate location and width of <br />alleys, locate proposed snd all <br />existing buildinqs, show distances <br />to property lines, show di.;tances <br />betWeen buildings. <br />Lot size X <br />Lot area Sq. Ft. <br />Size of Bldg. Sq. Yc. <br />Number of Stories <br />n35C^C^t <br />si9nca sy � G( �.-�/�-�e <br />f OL � <br />Owncr Phone ,i� 7-i-�t•l�/_ <br />R <br />Uce 7.one - — <br />Fire Zone <br />Occuoancy Group <br />Type of Construction � <br />Occupant.Load <br />Sprinklers Required <br />CITY 0�' EVERETT <br />APPROVED FOR aL'ILDI;'G f'�^°.11T <br />Date � i 6 7 S' ey �Z � <br />a <br />