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BUILDING PERMIT APPLICATION <br />Apilicnnt To Complete TIlip Form <br />If more than one building is'to be constructed, submit <br />application for each building. A separate permit will <br />building. <br />Owner <br />��/i Mts IiL�yn e• <br />Address yy-/y- G,/ s,' <br />City C'6, e t e t l Phone <br />Architect/Enginear <br />City <br />Phone <br />Contrartor j'y�y( Nees 1 '. iPYfit/(�p <br />Address <br />City et e # -_T> Phone J 5-3 - 92YT- <br />State License Number -7z3 _ of 9666' <br />Expiration Date S - / - y C. <br />a separaL•o per, i.L• <br />be issued for. each <br />Building Address ,S/`/ - G / s 7' <br />L6EG4' 4c-GS/L'�' <br />t% 1, duo 'or. Sr Bloch <br />Subdivision (Plat) <br />G—If ''AYUI w I ,&rrrc- <br />Metes & Bounds (Unplatted) <br />Seca Twp. Rge. <br />Building Use <br />Describe Wor). to Be Done <br />C010: _ PLOT PLN7 0?, REVERSE SIDE <br />tis7 c l.1 As' e "Y <br />Number o` Stories <br />Basement ,r <br />New Addition Repair/Remodel' <br />Valuation of Construction $ <br />Signed IIYFor <br />Owner Phone <br />DU Not Write Below This <br />Line -For City Use Only <br />Date Received <br />/'7 ee ' ' ' ' •' <br />Use Sone _ <br />Plan Check Number !lo -/a J' <br />Firo Zone 3 <br />Valuation <br />Occupancy -Group L <br />Permit Fee <br />rr2, aw <br />. Type of Const::uction I <br />Plan Check Fce <br />Occupant Load <br />Total Fee Due <br />_ le') _ °U <br />Sprinklers Required <br />Date Issued <br />J/ii <br />' <br />• <br />CITY, OF EVERfiTT <br />APPROVED FOR BUILDING PERMIT <br />Da(e ?�—ey J� <br />