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BUILDING PERMIT APPLICATION 212 <br />Ap il.icant• To <br />Complete This Form 375� <br />If more than one Wilding is'to <br />be constructed, submit a separate permit <br />applic.-Lion for each building. <br />A separate permit will be issued for each <br />building. <br />Owner Ken Bailey <br />Building Address4k1 Wearytew nr_E-wett <br />Address 4621 West View Dr. <br />Lot Block <br />City Everett Phone 7g7677R <br />Subdivision (Plat) <br />Architect/Engineer <br />_ <br />City Phone <br />Motes & Bounds (Unplatted) <br />Contractor <br />Sec. Twp. Rgo. <br />Address �i <br />City Phone _ <br />Statc License Number <br />Expiration Date <br />_ <br />Building Use <br />Describe Pork to Be Done <br />COl'T LiR PLOT PLAN ON REVERSE SM <br />Number of Stories <br />Basement: <br />New Addition Repair/Remodel, <br />Valuation of Construction $ <br />Signed By <br />For <br />Owner Phone <br />Do t?vt Write Below This Linefor City Use Only _ <br />Date Received Use Sono _ <br />Plan Check Number Fire Vonc <br />Valuation Occupancy -Group <br />Permit Fee Type of Construction <br />Plan Check Fee Occupant•. Load <br />Total Fee Due Sprinklers Required <br />Date Issued <br />