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� ( ( <br /> � , , , • BOILAING PETiMIT nPPLICATION • J9D -7� •,• - <br /> � I�pplicant To Completc This rorm �{� � �/�sh� n <br /> y <br /> I! mre th�n one bailding ir,'to be conctzucted, suCmit a sepnrate permit <br /> appli:ation for cach buildin«�. n scp:irate per.mit wi21 bc issucd Eor c.ich <br /> building. ' <br /> Q,,,ner �(, �f, ��9,(�iC. Su3laing nddress ,.�s3 o vri c.u14r� <br /> Addzess ��n Fn c,c6F,�//FGL— . �t I`�- Fi 14 � Aloc k 4'L"� <br /> rity ,r i�FeCi;..7'i Phonc .ZS� t�Jp'j bUbdiyisiort (Plat) _� <br /> Arahi:ect/Enqincer � 7NJP�� E'1�TM � f V • Qi- • ' . <br /> City Phonc Meten e no�nas (Unplatte�l) , . <br /> Contzr.ctor ,SA/NF Sec. T�ap. R9c. <br /> lkddzess , <br /> � <br /> City Phane • <br /> State License Number . . <br /> � Expizz.ion D�ce � , � <br /> � • . <br /> � . <br /> { � ' . ' . ' sutia�„g u5� �:9RPert i � , <br /> � Describe Hork to Be Done <br /> 1 <br /> 1 OQ�P..T•'• P!A! PLAH �1 AEPE.�E SrilE . - <br /> i - <br /> � . Nwnbez of Stories <br /> . . Sasert:en t <br /> i , . . <br /> � , � . � ' New � Addition RepaS,r/Acmodtl � <br /> � . Valuation of Construction $�G�OQ � <br /> - ' • ' ' �� <br /> i • ' <br /> � • , Figned Dy i <br /> " ' • . ior _ <br /> ' � Owner Phone <br /> • ' Do Rpt Flritc Bc1oN Tl�i� Line •For City Use Only <br /> Date Received 3��5 71.� ' ' ' ' '• � ��e Sonc �-� .Si� ���eo�� ` ; <br /> IflanGieck Number ZL-!9/ ' • ?ira Zor.e �3 <br /> Valuation 'Z6B�-�� " • Occup�ncy •Group S <br /> Peznit Fce •ZO•a Type of Conctruction , .r % � ' ' <br /> Plan ChecY Fce !O•�a Occupant Load <br /> 2ota1 Fee Due �SD. ad Sprinklcrs Required <br /> Datc Issucc3 • . . <br /> .. . CITY OF E�lERETT #`; <br /> ' � APPROVED f.bR �UILDI(:G 1'[IIMIT <br /> . . � ' �e_ . ; :...__By r . <br /> �� <br /> � • <br />