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�-.F'PLICATION FO�. <br />M� Er�r9rqn C:O N SY R�J C T! O N <br />cirr oF <br />ev�rett PERMIT <br />BUfLDI�VG DEPAFTMENT <br />2,g•g�q5 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION <br />�I t <br />cion <br />❑ COh1BINATION ❑ BUILDING ❑ MECHANICAL <br />%C '� <br />MAIL �0 <br />hl/ 'AOl���S � V/� / ��/' ` <br />cirv <br />cveren <br />� <br />❑ PLUh981NG ❑ SIGN <br />PIIONE�J /�, <br />�rj/� �V/r%'l �7 <br />�. <br />PIIONE <br />rMONE ,� uG r+s�� <br />-7�z=��� /;�FI-l!l IGJ���� <br />MLCMRNICAL WNTI1RGtOq MAILAOOBE55 C17Y � � ZIP PI�ON[ LiL[NS[ • <br />PLUMDINGCONiPAG1011 MRILA�DRE55 CITV 21P VIION[ LICErvSE• <br />I�OF WORK <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FR!'_.INSERT ❑ BUILDING RELOCATION <br />LEGAL �ESLBIViiON <br />ior—oioc� <br />�t <br />US[ LON� <br />�� <br />ACC <br />�Z <br />8 DISP. <br />ill <br />LAOORI <br />�.�`v I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED TFIIS AP• <br />PLICATION AND KNOW THE SAMETO BE TRUE AND CORRECT. ALL <br />pEIOWOfiAiiACMF0URG0?IESj PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br />OF WORK WILL BE �OMPLETED WITH WHEiHFR SPECIFIED HERE� <br />IN OR NOT. THE GRANTING OF A PERMITDOES NOT PRESUME TO <br />GIVE AUTNORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PEHFORMANCE OF CONSTRUCTION. <br />SIGNATUREOFCONTRACTORORAUTMORIZEOAGENT �TE <br />y"-y� � �. �� �jl�i� <br />Xl�/G�'(i�� i �GLL�Lc-.(. " <br />APPLICANTS CITY DUSINESS UGENSE NO. <br />- �A I � <br />WALL <br />1.11': <br />M <br />EA <br />TOTALF[E SI I I I TOTALFEE gl <br />1HIS PORTION TO BE COMPLET'�D BY BUILDING DEPT. PERSONNEL <br />BERBSE104CI{ SIDESETOAGN PL�NCHECKNUMOEN PL4NGNECKFEE <br />�� �� FEE RELEIPi IIO <br />LOiAREA ypCFNi51TE FEES VALUATION F[E <br />� OYES �JO <br />OCCUPnNCYGIIOIIP NO.OF�WELLINCUNIIS <br />� � �� BUILDING g 5 _ <br />NO.OF Sf001[5 tAn%OCQ LOAO <br />f �� PLUMDING <br />PI.ANS CIIEGKE� [ <br />��� <br />MEC�iFNICAL <br />� OTliER <br />PENALTY <br />pPl�R. FOII ISSUANCE BV <br />TQTAL <br />G_� - <br />FEE <br />