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; G ,�JJ <br />BUILDING FERMIT APPLICATION � % v / <br />�� ,� Applicant To Complete This Form . <br />� � � , 3� ��S <br />If more than one building is to be constructed, submit a separate permit ap- <br />plication for each building. A separate permit will be issucd for each build- <br />ing. <br />` . )� �f J.;,� i <br />Owner /' jm r� r 4% <br />Address S' JO „C •- 3,�, �. R ut' , <br />City � /��...�. ii Yhone,35.3- 5%?v <br />la'chitect r h., � ��= `�/c� v�li�.�. •,+ �- <br />City E� c. r�o N Phone �5�- 59Lr <br />° -! <br />Contractor �/,,,r r �1 ��rd iun� <br />naai�ss � >� � - .3:.�� ra �4 �� <br />City F•t�r��� Phone �53�SIL� <br />State License Number" :� -2_�-cj)-;'c%y <br />L>:pi�ation Dute �� - <% % - 7� <br />ZZ ' n�u l <br />`- -.. o �.. /lJt- /� <br />:. � . <br />si; <br />� <br />\ <br />� <br />Building Address �i S�•vr„a ',1`� <br />Lot 2 Blk. / Sec. ti r r! fd �n r ri r'ci ��� �/ c' �:, <br />Twp. Rye. ' <br />Subdivision (Plat) <br />!•fetes & IIounds (Unplatted) <br />Uu:ilding Use /'P �� �.l ,.. ., � •• L_ <br />Describe Wor}; to Re Done ,Y��c. ,_ <br />Use of IIuilding n• <br />'ti.New .-nddition . Repair/Fenodel <br />�� i� pc"� � L-- <br />Valuation of Construction $ �`� <br />Il1•J�O <br />B1:L017 <br />DaCe Recci.ved � C� ( � <br />Plan Check Rumbcr 7S'- I(0 4� <br />Valuation_ j� o �- oO <br />Permit I'ce 1 3O _ 03 - <br />Plan Check Fee � j, oJ <br />Total Fce Due i Q�� J v _ <br />Pcrmit Nunil�rr � <br />Date I5 <br />PLOT PLAN <br />Indicate lot size, name of streets, <br />in3icale location and width of <br />alleys, locate proposed and all <br />existiny buildings, show distances <br />to property lines, show distances <br />bet��een buildings. <br />Lot size i/,j'.,ix i�� s�! � <br />� Lot arca s.P./'J,c,:L<� <br />Size of uldg. �77v,.s3 5•F•'y3yl <br />NumUer of Stories � _ <br />Dasement i <br />Uce 'l.aie i' ����da t I _ <br />y �' / � ' <br />Signed DY ! �m/,/� /.d��L�`ro�GG`'rt-i � <br />t•or lrGi���u :+Z��'�'K'��'�� �� I <br />Owner <br />S LINE-PO�R�.sCITY USIi ONLY <br />£i.re 2onM^�� � <br />Type oE ConsCruction _� !J <br />Occupancy Group _r <br />Occupant <br />Sprinklers Required - � <br />CITI' 0� FVERETT <br />APPROVLD Ppi? �:,UILDING PER��11T <br />Date �� � �?� BY —�C�__._ _—,... <br />APPROV[D FOR f3UILDING PERMIT <br />Dale_ .,.. <br />