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BUILDING PERMIT APPLICATION <br />Applicant To Complete <br />This Form <br />If more than one <br />building is to be constructed, <br />submit <br />a separate permit <br />application for <br />each building. A separate <br />permit will <br />be issued for each <br />building. <br />�Eueraj�C � <br />of-�o.N,Ul, (uc. <br />Building Address <br />18C4 wsT. ST, <br />Owner <br />okClti2 <br />' <br />Address <br />Lot <br />_ Block <br />City )eye•} ate— <br />Phone25L5--53L <br />Subdivision (Plat) <br />Architect/Engineer <br />&NrEr- B, SVKRrA& <br />City q)r'(26Tr <br />Phone 25-8-5i7o <br />Metes & Bounds <br />(Unplatted) MIzQ5LZ* L 11 <br />Contractor cuNEfZ <br />Sec. 3_Twp. <br />z9 � Rge. <br />Address �Jhr t� AS hj&pQE <br />-- <br />City <br />Phone - <br />State License Number <br />Expiration Date <br />Building Use <br />Of4c,' VUILViIAG _ <br />Describe Work <br />to Be Done Veu4odel of <br />15-r. F, -lor' <br />ORNIS G1JTRCL- <br />Number of Stories <br />Basement <br />-New-- -AdrYi-tzan Repai. Remodel <br />Valuation of Construction $ tj50D.00 <br />Not Write Below This Line -For City Us <br />Date Received <br />Flan Check Numbc <br />7to IL5 <br />Valuation <br />Permit Fee <br />44-- 29 <br />Plan Check Fee <br />2 F, ii <br />Total Fee Due <br />n <br />7.�• <br />Date Issued <br />Use Sone <br />Fire Zone <br />Occupancy Group <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />I <br />CITY OF EVERETT <br />APPROVED FOR BUILDING PERMIT <br />Date `.- ` By"�° -- --t <br />