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BUILDING PERMIT APPLICATION <br /> Applicant To Complete This corm <br /> If more than one building is to be contructed, submit a separate permit applica- <br /> tion for each building. A separate permit will be issued for each building. <br /> Owner .� Building Address o'C/7 + 2rt �/�� �c-0 . <br /> Addre'" !_ Lot C Block/ (� <br /> CityPhone Subdivision (Plat) l� . � G. n Uw•X <br /> Architect/Engineer <br /> City Phone / Metes 6 Bounds (Unplatted) _ <br /> Contractor � may, �fG� 4-.Sec. Twp. Rge <br /> Address 13H0 J LU• <br /> 799 O <br /> City �y�/I� Phone YO Building Use <br /> State License Number _ Describe Work to Be Done <br /> Expiration Date <br /> SKETCH PLOT PLAN BELOW <br /> Use of Building <br /> ❑New ❑ Addition `R Repair/Remodel <br /> Valuation of Construction Sle 5,00 <br /> PLOT PLAN REQUIREMENTS <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 /> a '! to property lines, show distances <br /> between buildings. <br /> Lot size x <br /> Lot area Sq. Ft. <br /> Size of Bldg. Sq. Ft. <br /> Number of Sto s i <br /> Basement <br /> Signed By <br /> For <br /> Owner one <br /> DO NOT WRITE BELOW THIS LINE-FOR CITY USE ONLY <br /> Date deceived ULC Zone I <br /> Plan Check Number Fire Zone <br /> Valuation Occupancy Group <br /> Pernit Fee Type of Construction <br /> Plan Check Fee Occupant Load <br /> Total Fee Due Sprinklers Required <br /> Date Issued CITY OF EVERETT <br /> APPROVED FOR BUILD • f'F rWIT J� <br /> Date BY 1� <br /> i <br />