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/9�/3 . -
<br />; - -�/�i�- .
<br />, tf more than one huildinq is to be contructed, submit a separate permit applica �
<br />� ., tion ffor each building. �1 separate permit aill bc i.ssucd for each bui:ding.
<br />. " Qvner � i' � i � � � � � �; �� Suildinq Address ; =% �I �I -�-I .lr �' ,
<br />� �_�
<br />' � �ddzess Lot Block _ '
<br />. --
<br />; �tp Fhone � Subdivision (Plat) �,� �,• I^ I;�
<br />` � k-chitect/Enqinecr _ - ___� �
<br />• '.� `'� City Phone F(etes L ➢ounds (Unplatted)
<br />. -- =i --- , _
<br />. :� Con`s�actor ' � i � - �;',� � Sec._ � �+P. Rge
<br />- •�
<br />:.. r..� Eddre.ss /��' � /(--tf ��.C, . •
<br />' City -!I Phane �, _�.������ t,�:S.Ydinq Use �L ; .�- n , _,� �. .
<br />.' �
<br />'4� . _.. 'w' ' . ' � .
<br />�'�} State. License Na�nber ,__� /�`� �- i�scribe Work to Be Dune .� ` I
<br />- :
<br />� • .I hPiration Dat� " _ - , - _ "- � � .
<br />• . _
<br />�� � ' � . SICETCH PLOT PI.A:] BELOW' • � � ' . .
<br />.. . �; ' . . � '�. ' . ! . ,. • Dse of Beilding !- . , , . , - " °
<br />� �.
<br />�_,.-.�, _
<br />� � , ' ' . � . ' : ' _ :.' �' � �Nev ❑ Addition Q Repair/Re.:�ouel
<br />- •' • � ` .
<br />- ' ' � Valuation o£ Cor.struction S ��
<br />�. ,f�`,,• j . , Y .F , , �� � .� ' �:..�• ' � - •I . . P2AT PLA.`7 REQUI��L:1T5 _ _ •
<br />�., � . � � `' �< • .
<br />� v'
<br />�. �., .� • - Zndicate lot size, nzr..e of streets,
<br />�_ '..; ' .'1 • ' • 1 �inZica'e locatie^ aac wic�n of .
<br />, � �, . ��- _ . _ � �. alleys, locat� �ro�osec z: � zZ' -
<br />r e-�_- , .. _ � � � : . -_: - � . .. Cxistin^y builci:.c�, sna:a dis_�.^.ces
<br />.,n - ' to pr.ogerty linFs, sho:+ distznees
<br />t � � betucen buildings.
<br />� , . .- �� ��� / '-' '/�-' � I' *.ot size : , � `
<br />�. .,: � � .
<br />` 1 R r' . . . Lot ar�a Sq. ft.
<br />.•� . •' ._ . � . : Size of Bldg. `. �. _ Sa. FL.
<br />�� r. ` . F blumbe: of Storles �
<br />� -; �1' . ,_.____ . ; •... ' � Tiasement _L
<br />. . . --- � � " ' �
<br />r. ' �_ ` . .._ __.- .--:�-`.____.__ . . . ' ...
<br />+y . � . _ � _ _ S3gned BY - �, -
<br />_ i � .. � . _l-, , .. . �-_ � .
<br />. - For
<br />. _ . . . . � r�rner Phone �
<br />�' DO NO': S:':7??L 3�LOS'7 THIS LINE-r'OR Ci'PY USE 02IL'I ,__
<br />. .� � .-- ' w . .
<br />... -- Date Seceived �--s U r— 7 D�e Zone —
<br />' Plan. Cieck :�ur.Ser �7 S'ZZ�— Fire Zonc j �
<br />Yalnation 3� b'd �^ �z Occunancy Group T
<br />, _•— Cj p .
<br />Yeznit Fee l 3�j- 9j�pe of Construction �- 1-1 - '
<br />'' Ylan Check Fee � y- 6� Oceupant Load ,_ _
<br />� Total Fee Due Sprinklczs Required
<br />Daie Issue3 s/ Y 7 �� • ' . . CITY OF EyERETT . •,
<br />, • . :' � AP(�ROVEU• FOR BUILDING PERMIT� .
<br />. . �/ �
<br />, � .. �iate��,�L,�•'�a ' EY— •�_ _ '
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