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• . 1 ' . ' ' ' � DOILDING PERMIT APPLICATION . �. � ` , .� ? .{ •
<br />� " � • �,'.�1:
<br />, f • . � �pplicant To Complete This :orm / ��C'!'�
<br />^ � I . ' � S�� ��S '� .
<br />'.' :t more than one buildinq is to be eontructed, submit a separate permit applica-
<br />� „ tiop for each buildinq. 11 separate permit will be issued for eac�hf /b�Ju' din /�/
<br />' i 1 '�/�./� �• �'�� .
<br />, . � 'pvner ?� Hntldinq Addzess
<br />,
<br />� ' 3Edress � Eot 5 Block O/,�' '
<br />,+
<br />; L y i t, ,
<br />� City L 1„�� � Yhone � 5' �-17C i Subdivision (Plat) � cu�r �� •
<br />. � 2 ,
<br />• '� � lrchitect/Enqineer ' '
<br />•;i��..`._'� City Phone ISetes i Bounds (Unplatted) '
<br />�. � . -
<br />. ';,. Contractor ' Sec. iVp.' 84e
<br />,..� . . .
<br />'-. ' � . i. . � •
<br />.;• �dIIress _
<br />�!, a Phone Bu3lding Use �' `i u � c G '"': �
<br />tY l' , =��,
<br />' � �� . .'.:'.' . v'."Y.•�.
<br />. y� State,License Nwaher Describe Work to Be Done /�,f�i(/ �,
<br />. r ,. � .
<br />� • • :I . bcPization nat� _ N, � „ ,�'� c�� =,. v n� ,.-�i �, vwo- �..
<br />:�' '�jj � SI�TCFi PLOT YLAN BEIAW" •. . . � ..
<br />_' .� - .... ' . . . ,.. - � • Dse of Buildinq ��,a��4 .<%��iio..`�,�, . .
<br />� j ' ' ' , . ' � ONew ❑ Addition �Repair/Remouel
<br />i' .,
<br />� � �'� � . � � . . . • Valuation of Construction 5 �� L�Z'a ` " �
<br />.,,.. i . . . � . : .' . . � ' . � , � P24T PLAN REQUZRFSIENTS . � �
<br />-� • . � , ' � . .� . ' . • .. .
<br />. � •
<br />•,� . . • _ • . • ' Iadicate lot size, name of streets,
<br />• �. . . . •� �iitdicate location and width of
<br />T:;.•
<br />. ,.I � " ;:' � . , � alleys, locate pronosed and all .
<br />. •. ::� _ �- - ' ' ; , - _ .' � lxistinq buildings, shot.• distances
<br />r-:� .�?�� -. to pzoperty lines, show distances
<br />' , i't - . � � � • - : � betw�:en buildings. �
<br />�. i . � • " � . � _ '
<br />. ' - • . � � ' . ' . ' • . ' .LOt S�.ZC �....� X
<br />y'. . �• .
<br />,_. � • • ' Lot area Sq. Ft.
<br />. - r:'�7 ' . , .• � ' Size of Bldq. Sq. Pt.
<br />•� , • , Number of Stories �
<br />. :_ i- , • . . � , . 8asement
<br />::..� , n /� � , , �
<br />•.� • _ .' � . . . - . � � Siqned By Y� „�, �if4 d.�.,��i, %''r,1�-c.
<br />�• � .. . . . . � � . . � i i� �" ��� �, c � , .
<br />f , . _ For -�aw�/; L_,s,�t�,
<br />. . - .. - . " O�aner Phon .2 �S -'L /C / .
<br />�-� � � DO NO': h':iZTB HELOhl THIS LI;4E-20R CITY i1SE 0272.'L �
<br />-� �— Date S^ceived S�/3I75 Uce Zone i��-
<br />. . . � . T� . . . �
<br />' Plan. Check :Jur,ber %5-Z3 T Fire 2onc 3'
<br />Valnation C�-c- �-� .� Occupancy Grou� _ ({ - t �.
<br />' Pemit Fee � `Y� � � Sj�+e of Constructian � y - ti.1 . ' �
<br />,' ' Ylan Check Fee �� �/,-v� 0ccupant Load . �
<br />, � Zbtal Fee Due %`� �� Sprinklers Required
<br />• Datc Issued S ' � • ,. � CITY OF FVERETT , ;:
<br />. • ': � APFRGVE�..fC�R [31J1'_D1Nu �PERMIT ' � `
<br />•. , . , . • �.• • , • • i/��,'.
<br />. � ' .. ' . .Date._a=,l;i%.'7�6y-�..
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