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BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form u <br />If more than one building is to be contructed, submit a separate permit applica <br />tion for each building. <br />d <br />A separate permit will be issued for each building. <br />Owner T / / / Building Address IZL ? ( �/ S / i <br />Address LotBlock <br />City Phone Subdivision (Plat) .C,O.(s )_ <br />Architect/Engineer <br />City ,-Phoo]ne Metes s Bounds kUnplatted) <br />Contractor /7 C,//� CC "--Ir f r4o /SSec. <br />Address V e h' Z 72e ,9L-( <br />_ / <br />City f-, Phone 7 r �� (1 Building Use <br />Twp. Rge <br />State License Number Describe Work to Be Done <br />Expiration Date �� - L 7 r <br />SKETCH PLOT PLAN BELOW <br />Use of Building <br />[]New ❑ Addition Repair/Remodel <br />0 <br />Valuation of Construction <br />PLOT PLAN REQUIREMENTS <br />Indicate lo, size, name of streets, <br />indicate location and width of <br />alleys, locate proposed and all <br />existing buildings, show distances <br />to property Lines, show distances <br />between buildings. <br />Lot size x <br />Lot area Sq. Ft. <br />Size of Bldg. Sq. Ft. <br />Number of Stapes i <br />Basement <br />Signed By <br />For <br />Owner Phone <br />I <br />DO NOT WRITE BELOW THIS LINE -FOR CITY USE ONLY <br />Date 7nceived U_e Zone <br />Plan Check Number Fire Zone <br />Valuation Occupancy Group <br />1 <br />Permit Fee Type of. Construction <br />Plan Check Fee Occupant Load I <br />Total Fee Due _ Sprinklers Required <br />Date Issued CITY OF EVERETT <br />APPROVED FOR BUILDI G PERMIT <br />/! 64 <br />