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•r� EYNprNn <br />ITY Of <br />�verett <br />SUILDING DEPARTMENT <br />'S9•8745 <br />�%<.� J�caP��sv,_. . <br />`._.PPLICATIC�N F0►_' <br />CONSTRU�CTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />1 DEMOUTION ❑ CQMBINATION �BUILDING ., p MECHANICAL ; <br />.vN[R , MML�DDPE55 , CiiY =iP . <br />�C��c'l. �.i? <br />❑ PLUMBING <br />� <br />❑ SIGN <br />KobtrT' C.. �w1 ft.l.ft.,14�1 WlsT 1`lluctltorl � St�1R� °IBII°I 'Zf�3-83b(o '�321? <br />'i�ER�tGOMTqIiCTOR . • M�II�DOPE55 cm ziv PHONE �y�E���3:��1K <br />�5�x.c�c,l�n, C�sr. Coluc. 14ot {�lEsc- NKreicsonc �Se�,ec�rct a0�tq ze3-e3r� °. <br />�fH�NIW4CONTR�CiOq MMI�ODRESS CITY ZIP PHONE LICENSE• <br />�IDVlL DdSI�NTD'B6S6uE�� <br />UMBINOLONtR�C10F M�IL�DOPESS Gfl ZIP pIIOHE LIGENSE• <br />�1C717tIL QESIEi[1J�C �f SEC6G�'�j� <br />- ,ss ov wa+� y�{ <br />�NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ,Gr�DEMOLITION ❑ WOODSTOVE/FRPL.INSEflT ❑ BUILDING RELOCATION <br />:� • <br />]VXItl[ Y�VMR <br />�MIO�ASH AN tlllsf q1,y gr�p <br />.r er eUaoieo <br />$• 2 �cv�l� <br />(:�l DESGRIPiION Of PROPERtY�SMOWN BELOW OR <br />Lvrvvcca�� et�ir) <br />dtlsf.'i►Vu�c � mn�SfRc�ci' TICY fe9oosF f.:[CML bt.t7� 1�11'M 6r6 WcM►� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PIICATION AND KMOW THE SAME TO B[TRUEANDCORRECT. ALL <br />^'E� PROVISIONSOFLAWSANf10flDINANCESGOVERNINGTNISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHEH SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OFA PEFMITDOES NOT PRESUME TO <br />• GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIONRTURE OF W 4 OR OR AUTHOR17ED A6ENi �, OpTE <br />'• �`KL(� <br />!'1,�9e7. <br />►..1. f31�o�N� <br />TI'PE OF FI%TURE � <br />OSE7 TOILE � <br />',�W�SH8A31N) - ' .i <br />iINK 6 DISP. <br />IER <br />TRAV / <br />N0. <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />�ONi$ETB�CN <br />N �- <br />E 20NE <br />,� - a <br />�`EOf-�T. � <br />ze or e�/oa(�� <br />(�dv� <br />IION ACG. BV <br />�'� r <br />NR- <br />3,6oa i. <br />�� � ) �.7 � a <br />>. OF STONIE9 <br />� <br />o n ves Nc <br />ANS CMECNEO BY <br />/ <br />VAC�NT SITE � � <br />DYES pN0 <br />NO. OF UWELlIN01 <br />� <br />M�X OCG.IO�D <br />22 Cn <br />I. FOF 195UANCE BY <br />G. �, <br />IMBER PI�NGMEGNfEE <br />//`^� f iEE Gn�� IRECEIPTNO i <br />� IT u- ✓ 7 <br />/ � <br />FEE6 V�LIl�TIDN FEE <br />a���o�Na .tPq�, qtq � <br />rwMeir+a <br />MECHANICAL <br />OTHER <br />PEN�LTY <br />TOT�L � I <br />R-rau. � Mw+� -ro � u�►� <br />��'� P�'trs. i � � �� <br />�-�•� <br />