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BUILDING PERMIT APPLICATION <br />Applicant To Complete This ?orm <br />If more than one building is to be contracted, submit a separate permit applica- <br />tion for each building. A separate permit will be issued for each building.s�I <br />OYner 1�.� ) C (,�{64 Building Address �/o D — G 3 ,S74 <br />Address Lot_. Black <br />• City Phone Subdivision (Plat) �yi %31J. j7a-t ( �24i �, <br />Architect/Engineer <br />•� "°i city Phone Metes L Bounds (Unplatted) <br />ti r <br />Contractor J 'K 2 , r • Sec.Twp•__. Rye <br />Address �O�V��— •� <br />city -v�Y< Phone eh.l5 O -IST A d Building Use <br />} State License Number h. �. 3 �-ei 1 y 93 9 Describe Work to Be Done <br />Expiration Data <br />a ; <br />i <br />7 <br />I <br />SKETCH PLOT PLAN BELOW' <br />: fw v . <br />Date Coceived <br />— (( <br />Plan Check ,yurber TS <br />Valuation <br />Permit Fee <br />Plan Check Fee <br />&4- <br />Total Fee Due <br />. Date Issued <br />21 <br />use of Building Jiv aL+ Y <br />4^aw ❑ Addition ❑ Repair/Remodel <br />Valuation of Construction <br />PLOT PLAN REQUIREMENTS :h <br />Indicate lot size, name of streets, <br />'indicate location and width of <br />alleys, locate proposed and all <br />existing buildings, show distances <br />to property lines, show distances <br />between buildings. <br />Lot size_x l G O <br />Lot area Sq. Ft. <br />Size of BTxg. —_ Sq. Ft. <br />Number of Stories <br />Basement <br />—J3lgned ByC <br />For <br />Owner Phone <br />Uce ZOna <br />Fire Zeno 3 <br />occupancy Group Z <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />CITY OF EVERETT <br />APPROVED FOR BUILDING PERMIT <br />beta � � GJ � ar ey _•.�L,.s;_-. <br />