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13UI7,DING PI:RDiIT APPLICATION
<br />nPPlicanL- To Completc S:hi.s Porm
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<br />If more than one building is to be constructed, submit a separate permit
<br />application for each Uuilding. A separaL-c permit will be issued for each
<br />bui.ldiny.
<br />Owncr 'r. 5�.� LG,o;.� = Building nddress _.:l::, -
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<br />Address ._: /% �� J �i,,l. Lol- - •' -
<br />- �.: '131ock _ L. •, ,
<br />CitY �'vGi•' '� "' Phone ��.'•- Subdivision (Plat) � ! a ;.1 ' � 1 ;� �%� ! ;
<br />Archi.tect/Engineer j r : � : ' .. - . - • �'� � " , . • . ;? -
<br />City
<br />Phone
<br />Contractor L� Jr'-; �, �: � ' , r?�i/,.-'1Jr; � '�
<br />Ad ess �r1�; � �-� ,�;� d.C�
<br />ty _:'�.o- �ilr� � Phone �5':> �%':- �
<br />State I,icense N.umi�er:':. .:.- o/-��'s:.i'3
<br />Expiration Date y, - -/ - G,
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<br />nfetos--&-Bounas—(Unpla tto�c 7--�
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<br />Sec.- --Twpc - _ Rge.
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<br />13uilding Use
<br />Describe Wor}:
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<br />-=�-•"`Y.���.c.�l�:I..'/' i..�/;f',:;.._-
<br />Co IIe Done ri-���,il%
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<br />� ! -; %;'� �i�_ `- ' G- -;�,• - ;_ , .
<br />Numb�r oL Stories �Ti;IL?
<br />�iV'�:�-[�rss�w�- - \ B�Setriellt /I )!/�,
<br />NecaJ ndd�tioi� Repair/Remodel
<br />�._�
<br />Valuatior. of Construction $
<br />_ � 31 - _ � -
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<br />`�'..�' -' _ Signeci. Dy `�i�./� �,�c.-� , c . , .
<br />%� i%. .vS+`�mTiivo �+d.v �>
<br />For /,. , •_i.� n . �� .
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<br />- - Olaner Photte
<br />___ __Do NoC l•�ri-te I�c].o�;� '1'hi; Linc-i_oT- CiL-y Use Only
<br />Date Recci-vcd % Q � Use Sone � zy �i,vu.e- �. Lo�rJ
<br />LT1anCheck NumUci Co-/Z5 P'irc• 7.one �3
<br />Valuation 3S� �'
<br />O Occunancy Group ,�
<br />l�ermit Fee `
<br />2�'�1 Type of Construction _;,� - � i
<br />Plan Checic I'ec /Y � Ocr_upanL- Load
<br />'1'otal Pee Duc 9Z- _�— _ Sprinl;lers 12equired
<br />Dat:c ] ssucd
<br />ciTY Of EVERETT
<br />APPROVED FpR BUILDING PERMIT
<br />Date '��---- g1'----
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