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e <br />' 31'Y17BUILDING PERMIT APPLICATION ,fd� 7c <br />API?licnnt To Complete This form <br />If more than one building into be constructed, submit a separato permit - <br />application for each building. A scparatc permit will be issued for each <br />building. ff �p *//? I <br />Over Iv ~ GhNv1, Building Address 73`Sr <br />Address % w n� i < c� Lotiiu nI-t //,0•/'L-Block 2 <br />CityLXXo1_,Kwt Phone33 -�'-77-7 Subdivision (Plat) <br />., <br />Architect/Engineer SDI L 9 <br />City Phone Metes & Bounds (Unplatted) <br />Contractor pmp,gLGQ CwJ Sec. <br />Address yi23 a RA. r-- <br />city4Avh_yt Phone ].S 00 _ <br />State License Number •2 3 3C L --/ LLZ 4 _ <br />Expiration Date <br />COIATL PLOT PLAN ON REVERSE SIDE - <br />Do Not Write Below T <br />Twp. Rge. <br />Building Use <br />Describe �+t•1-ork to A Done _ iEw <br />CoNs V r�..c,V IG�v <br />Number of Stories <br />Basement DLO <br />New Addition Repair/Remodel: <br />Valuation of Construction $`/_ 7}� <br />l3igned By <br />For <br />Owner Phone3>/-6377 <br />-For Ci <br />Date Received <br />- , - ' • • - • - <br />• Use <br />Sone ;'-Z <br />Man Checl: Number <br />i � — 1 • <br />Fire <br />zone <br />Valuation <br />Pornit Fee _ <br />Plan Chc .k Fee <br />Total Foe Due <br />Date Issued <br />occupancy -Group i <br />Type of Construction ,\I i � <br />Occupant Load <br />Sprinklers Required <br />CITY OP EVERE*TT <br />.-APPROVED FOR BUILDING PERMIT <br />Dale--11 By t/' <br />