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BUILDING PRRMIT APPLICATION y 7 <br />' Applicant To Compl.etc This Form <br />If more than one building into be constructed, submit a separate permit <br />application for each building. A separate permit will be issued for each <br />building. <br />•, <br />OYmer lf�i���ncc�.S x Building Address 03VWf_ <br />Address ir) 16 7 U't` CLot B Block <br />City _�J9 � Phone Subdivision (Plat) E0,37 112Sk) <br />Architect/Engineer SninC' <br />City Phone Meten & Bounds (unpltit-ted) <br />Cont_acL•or Soc. Twp. Rqc-• <br />City Phone <br />.State License Number <br />Expiration Date <br />C01T127- PLOT PLIX ON REVERSE SIDE <br />to <br />Date Received <br />r1ancheck Number <br />Valuation `Q <br />Permit Fee <br />Plan Check Fee �i'Ti t9 O <br />Total Fee Due kk. ®=o <br />Data Issued <br />Building Use , <br />Describe Wnrk to Be Done diF• <br />,mom <br />Number of Stories <br />Basement fn nit <br />New Addition r./ RepaiRemodel' <br />Valuation of Construction $� <br />Signed BY <br />For <br />Owner Phone <br />As Line -For City Use Only <br />Use Sono <br />Fire Zone S -- <br />occupancy-Group T <br />Type of Conctruction <br />Occupant Load <br />Sprinklers Required <br />CITY' OF FVERETT <br />APPROVED.FOR BUILPINO PERMIT <br />' Dater <br />0 <br />