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.. , z - <br />. I lOILDINC PEAMIT APPLICATION . . • .�•�•,T <br />" • Jlpplicant To CORplete This =orm <br />•' ii more than one building is to be contructed, submit a separate permit applica- <br />� tion for each buildinq. �1 separate permit vill be issued for each building. <br />i <br />. . Ovner ,'�' -,..��� /f/r'ir!r �"= Buildinq Address ; ::��.�.'i. . <br />,, lddre3s i�y��� l� �.•.%" �/r-'I�' ��/� Lot • Block <br />City �� � � PhoneJ�J.-�%S/•F' Subdivision (Plat) � <br />' � lrchitect/Engineer � <br />`'� City Phone Netes s Sounds (Unplatted) � <br />- - 'i — <br />:� Cont.-actor �;i�-�in' 1�,-�� ,� r'�%i,l; •:)'Sec. lt+p. g4e <br />.' . . ' 11t...ress � ''��.� _ >. � .,-" � ' • <br />_ • � <br />� City i/ Phone '�%" iJ'%'� Building Use _ "": i:'. <br />�-.; ,: . <br />�� �'� - State License Nuraber," �`�Li/��� ��� "�' `` Describe Rork to Be Done �'� � <br />e— . <br />' � � � . � �;. i . . /. i -: i ,. l/,'�, .. �';,��;��✓. � � <br />. �I yzpiration Dat� i � � 1 � = �• '":.iJi, i <br />.'•: -� � SICETCH PLOT PLAN BEL019' • � '�I. �" �.�� _ . <br />• � � IIae of Building � <br />:� . . .. . <br />� : � . _,- _� �., , _ �(New ❑ Addition Q Repair/RenoGel <br />• ' " r`(`'" ` : — �'j • Valuation of Construction 5 ' ''' ` <br />t . . � <br />y� �. � � . �. . . . . I: . . PI.OT PLAN REQUI?2ESIENTS � . � <br />: 'I <br />• . I . '. • Indicate lot size, nane of s:reets, <br />� - ; . -----J ' -iadicate loca;ion anc :�ic.n of <br />' �---,----- . . ! <br />. � �' . .' �' alleys, locatz nroo<ised a,^.d all <br />'� � " � ! ��a=1 existina buildings, show distances <br />�. : .� . i'�-.y��-.. �_- .. y � , � e'^?'..'(-7 � -. to property lines, show distances <br />- ' ; ' ' � ' - between buildings. <br />� ,� JLF'�i-�-- / _ <br />Lot size x <br />�.� s � - . Zot area Sq. Ft. <br />- - � Size of Hldg. � Sq. Ft. <br />.; r' . . Number of Stories �_ <br />�� ' , � Basement � <br />w'.. • _ �- . _ '_-- � <br />' � _ — .. Si9ned .Sf . .;,;. -,,. %f- . <br />� <br />' ca9i / /i'//';,'.%��� '- <br />� �� <br />� � � . Owner Phone •y , _ <br />DO DIOT S•:ZITS E�LOi1 THIS LINE-c'OR CITY USE Oi7L7 <br />Da[c S:ceived Uce 2onE <br />' Plan Caeck :tur..bez � Fire 2one ' <br />Valcation Occuoancy Grou� <br />Pecnit Fee Typc of Construction <br />Plan Check Fee Occupant Load - r'n r n ��' �l <br />' "ii 1'� '�� �� <br />S rinklers Re . ire � 1��� <br />,' lbtal Fee Oue _ P 9 — <br />Datc issued �� � . ; . , ��n`R 1•-7 �Ql� - <br />' CI'fY ,OF EVER�TT <br />' , � Inspection Dept. , <br />