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u <br />13UILDING PERMIT APPLICATION <br />Applicant To Complete This Form <br />If more than one building is'to be constructed, submit a separate pm:mit <br />application for each building. A separate permit will be issued for each <br />building <br />Owner Building Address <br />Address /lJ — i? J% Lot Block _SE <br />City ' � % Phone me Subdivision (Plat) <br />Architect/Engineer <br />City Phone Metes & Bounds (UnplaLted) <br />Contractor a�� �/,�%,�ti. �,cr�_ Sec. Twp. Rge. _ <br />Addre-ss <br />City Phone ;.?, r3--,j 0 <br />Statc License Number a� j_,��_ ♦7 rq <br />Expiration Date <br />P <br />Building Use ..1 1( <br />Describe Ylork to Be Done <br />COIPL _F PLOT PLAN ON REVERSE SIDE <br />Number of Stories <br />Basement <br />New Addition Repair./Remodel' <br />Valuation of Construction <br />Signed By <br />For ri-�% �✓7liY✓�ir` �- <br />- <br />v <br />Owner Phone3 <br />Do Not write Below This <br />Line -] or City Use Only <br />' ' ' ' ' <br />E <br />Data Received Z-111417Cy <br />Use Sane <br />4 <br />—T <br />1Tlan Check Number %Ln <br />Fire Zone #3 <br />Valuation zae� �� <br />Occupancy -Croup <br />Permit Fee DcD <br />Type of Construction <br />Plan Check <br />Occupant Load <br />Total Fee Due <br />Sprinl:lcrs Required <br />Date Issued <br />CITY OF EVERETT <br />APPROVED FOR BUILDING PERMIT <br />Date By _ <br />