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•. ' 1 y BUILDING PERMIT APPLICATION /�� 1.��..•} <br /> Applicant To Complete This corm /` 3 <br /> If more than one building is to be contruct.ed, submit a separatepermit applic, <br /> tion for each building. A separate permit will be issued for each building. <br /> Owner ACk 'n, f7 �Fi Building Address <br /> Address �I .� - ( � Sc .j Lot ( Block Oo .A-- <br /> City l // Phonei ' f Subdivision (Plat) <br /> Architect/Ei.gineer _ ct/�/iuc2Sf [Ji ✓• P> <br /> city Phone Notes i Bounds (Unplatted) <br /> Contractor how.✓; 0a &,,f414 F-Gri,.b one. Twp. Rge <br /> Address 4V ID 1 2 S-ty- <br /> City t 4dAJf,0 oo d Phone 776 t/fy Building Use 1'c <br /> �i State License Number y2.2 70 .� I f-10 Describe Work/to Be Done ' <br /> Expiration Data <br /> SKETCH PLOT PLAN BELOW• - <br /> . i Use of Building i <br /> r�._ MNew [3 Addition ❑ Repair/Remodel <br /> Valuation of Construction $ i <br /> y PIAT PLAN REQUIRDENTS <br /> Indicate lot size, name of streets, <br /> ' indicate location and width of <br /> alleys, locate proposed and all <br /> exicting buildings, show distances <br /> I V oi� to property lines, show distances <br /> a (� between buildings. <br /> J� Lot size x <br /> •' ! Lot area Sq. Ft. <br /> r, = �-d-'- Size Cf 8 g. Sq. Ft. <br /> Number of Stor ems- <br /> j \. Basement <br /> Signed By <br /> a. For <br /> Owner Phone is 5-3 - '3.. / •? <br /> DO NOT larTE BELOW THIS LINE-FOR CITY USE ONLY <br /> Date Received Me Zone <br /> P1an.Check Number Fire Zone <br /> Valuation /C Dy Occupancy Group <br /> Permit Fee G <br /> �. � Type of Constructi <br /> Plan Check Fee �- Occupant Load JUN 19 197 <br /> Total Fee Due Sprinklers Required C TY OF EVERETT <br /> Date Issued �,01417 inspection DepL <br />