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� '� 6 <br /> L <br /> /�/�' i l <br /> F3UILDING PliRMIT APPLICATION <br /> CI/�'.7 <br /> Applicant- To Completc 'J'liis Form <br /> Tf more than one building i.s to be construcLed, submit a separate ?ermit <br /> appli.cation for cach Uuilding. A separai:c permit will Ue issued for each <br /> building. ,.t t- � <br /> Owner 13ui.lding Address �(��- �!C{�M4MtS'K!'-� <br /> Address� Lot � II].ock _ �al't��, <br /> City Phone _ Subdivision (Plat) 'f���..,__ ,�,"r,�,��Z, <br /> Architect/Lngineer <br /> City Phone MeCes & IIounds (Unplatted) <br /> Contractor (�,.,Q„_�, f�y,�..a- �,(�, Sec. Twp. _ Rge. <br /> Address �, � {�r../��17,5 _ <br /> City �,_.��_ Phonc 7-3 U-� � _ <br /> State Licensc Numher. �j7_� / � )� s�nk� <br /> Expirati.on Date �3 — 7a; <br /> 13uilding Usc �y,����_(cs� . <br /> Describe Y;ork to IIe Don:^. <br /> —�,^ .-��c'w.,�> ---.- <br /> Number of Str�ries �_� <br /> IIas�nt � <br /> Cidew Addition Repaix/Remodel <br /> Valuation of Const�uction $ <br /> v <br /> �?�,� fL� � _ <br /> Signed IIy ,�i� <br /> For <br /> wnc� Phone <br /> Do Not l4rite IIelo�a This Linc-For City Use Only <br /> Datc Reccived �� • Use Sone _ <br /> I�lan Check NumUer '�o `"�G`� �/ rire 7.one _ S <br /> Valuation q�,�'CJ•� Occupancy Group 1 _ <br /> Permit I'ee 1�0� G�� Type of: Constructi.on _�- til _ <br /> Plan Check L'ce ��• S`-� Occupant Load <br /> Total Pee Due Spri.nklers Required __ <br /> Datc I�_;ucd <br /> CITY OF EVERETT <br /> APPROVED FOR BUILDIf�G PER�41T <br /> Date-l / 2.i �Z�_g�, �_ � <br /> - - � _ y - - --__ "- - --- - <br />