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0 <br />.. . _ <br />_.......:_ .._. �.... , _:.:.�,_ :.: ._:.�...._... ..,__. _._..._. _...,�...,�,�w <br />i <br />�;,PPLI�ATION FOi� ���,�„ <br />rn.Ewro�»� C�ONSTRU��'!ON <br />cirr oc � <br />everett PE RM IT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259•8745 ❑ COMBINATION l� BUILDING ❑ MECHANICAL ❑ PLUMBING � SIGN <br />OWNER MRILAU�PE55 CITY ZIP PHDNE <br />EVE�t6Rr-E C.9i�aP�s DG,�zA �gis E�F,�,� W�r .9gt°3 ` <br />ARCMITECTOROESIONEH MRILPDORE55 CITY ZIP PHONE ^j�'L-�]ty0 <br />�ENEp�1.CONTRACTOB MAILAOOFE55 dTY ZIP PHONE �-M32SZ�a5E• <br />Ni9T�oNftL 5i'6.cJ G�o�� /2_55 vEsT/A�,L N. SEf}�/��y. q�-/o�/ Z�o7bo <br />MEGHANIC�LCONTMCTOq MAILAOORE53 CITV ZIP PMONE �LICEN9E• <br />� � i . .� <br />PLUMBINOCONTMCTOfl MAILAODFE55 CITY 21P PHONE LICEN9E♦ <br />i: <br />CLASS OF WORK :!� � <br />� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDING RELOCATION <br />V�L ATIONOFWORK�COSTOFMATERIAl9PW5LA90ii� <br />gj 000• Oa <br />UESCHIBE WOPK <br />�NS#}L 1- A�N D/I1 /'} l� lTR//l.J pNL- <br />uae oF euamNa <br />LEO�L DESCRIPTION OF PflOPENTY (9NOWN BELOW OR AT7ACH FOUR COPIES7 <br />LOT '-BLOC�OF �� <br />5 �� �rr-�c,/Fa ��'�'A� to <br />5 i�� i�Li�n�• <br />�-//��E is tio C,[�.�c�� 9DD! <br />PROJECTAD�PESS <br />�S � %ei$ cz�/EC-/�%�..Ar <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP•,�.. <br />PLICATIONAND KNOW'iHE SAMETO BETRUEANDCORRECT.ALL <br />PROVISIONSOF LAWSAND ORDINANCESGOVERNIN�THISTYPE <br />OFWORKWILLBECOMPLETEDWITHWHETHERSPECIFIEDHERE�' �� <br />INORNOT.THEGRANTINGOFAPERMITDOESNOTPRESUMETO ��� <br />GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISIONS OF�� ��.�: <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION �:�. � <br />OR THL PERFORMANCE OF CONSTRUCTION. �, <br />SIONATOFE OFCONTRACTOR OR AUTHOFIZEU AOENT DATE ��� � <br />X � _ � �%�� i._ � �� �_�",' <br />THIS PORTION TO DE COMPLETED BY BUILDING DEPT. PERSONNEL <br />flENHSETBACN SIDESETBRCK PLFNGHEGNNUMBER PLANGMECH <br />USEZONE_ , LOTAREA <br />SREOFBLOQ <br />�` .. <br />APPLICATION AGC. BY <br />VAC�NT 91TE <br />OYE9 ONO <br />GPOUP NO.OFOWELLIN <br />IE9 MAK OCC. LOFD <br />9 ❑ NO <br />KED BY �PPH. FOR ISSUI <br />�Z�l°(9 / <br />FEE HECEIPTNO. <br />FEES V�LU�TION %vG <br />BUILDINCi E . - <br />PLUMBIN4 � �_ <br />ME(:HANICAL <br />OTHER � . . . �.., ' <br />PENALTV . �. � '�� <br />/ TOTAL <br />r <br />. <br />t: <br />__ S. <br />i.. <br />�� 4, <br />_ _ l.. <br />_. f <br />k <br />_ _ F' <br />j. <br />__ 'r' <br />�'f <br />54Lln.! zL� Pve" ��-�- �'�'-� _ F� <br />P�lv� o s <br />� �� ,•� }{��^� <br />