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r <br />fhe EverD�een �4���� P L I C A T I O N F� R�1� <br />°�TM°F CONSTRUCT�ON <br />�verett P E R M I T <br />TO BE COMPLETED IN BLACK INK- PLEASE PRINT <br />BUILDING DEPT. <br />259•8745 ❑ COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUiN81HG <br />OWNER MAIL� �hE55 IIV / 21P pt10nE <br />�'�`v . c' f: e� � �/ �,�F' /�/'� t�n,Y ,4//� �..3 ('� �•%, r6. �l,s!v� �i�/P/ /—,�7/G <br />OENEHnI <br />hlrllL Ao0fiE55 <br />���«�� ' <br />� <br />❑ SIGN <br />�6�� —���� <br />� <br />LICENSE • <br />❑ NEW ❑ AD�ITION I� .4LTENhTION ❑ F[PAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERi ❑ BUIIDING RELOCATION <br />VALUATIfJJ�pF WONK�COST OF MRTERIALS PWS IF�OP� <br />LOT—_ <br />PROJECTAOORESS <br />�% i Q <br />USE <br />' /� ' /�s <br />"ol ia �!%[ J 7��0 /_� i:S%� �o l!/n <br />L���s I HEREBY CERTIFY THAT I fIAVE READ AND EXAMINED THIS AP• <br />�� PLICATIONAND KNOW THE SAME TO BETRUcAND CORRECT. ALL <br />'ERTY�SHOWNUELOWOPATTACIFOURGOPIES� pqOVI510NSqFLAWSANDORDINA.NCESGOVERNINGTHISTYPE <br />e e � Q OF WORK WILL BECOMPI.ETED WITH WHETHEqSPECiFIED FiERE• <br />F IN OR NOT. TF!E GRANTING OFA PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� <br />ANY OTHEFi STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATIIA FCONTR�CTOR RAUiHORIZEDAGENT ON° <br />X, ������ ��/�s^ <br />AIR <br />Boi <br />Efi <br />r <br />THIS PORTION TO 6E COMPLETED BY BUILDING DEPT. PERSONNEL <br />HEARSETBAGN SIDESET9ACK PIFNGHECKNUM9ER PU��GNEGHFEE <br />FEE NECEIPiNO. <br />LOTAREA VpCAIJT5ITE <br />pYES ONO FEES VAtUAT10N FE[ <br />OCCUPANCYGROOP NO.OFDWEllIN0UNR5 <br />RPPLICATION RCC. BV <br />IiG] <br />BY <br />BUILDINO S <br />MAX OCG LOAO <br />PLUMBING <br />MECHANICAL <br />OTMER <br />PENALTV <br />APPR FOR ISSUANCE �V <br />TOTAL <br />Z <br />O <br />� <br />i--� <br />C� <br />m <br />H M� <br />� � <br />.. --i <br />�m <br />O <br />co <br />mo <br />-� c <br />O 3 <br />m <br />_� <br />m <br />c` <br />�_ <br />H �--i <br />�--� V1 <br />J <br />� � <br />�1 A <br />3 <br />-i m <br />x <br />m� <br />N <br />O <br />o r <br />c� m <br />C N <br />3 � <br />m <br />z� <br />�r <br />. m <br />a <br />z <br />� <br />2 <br />a <br />z <br />� <br />x <br />.. <br />N <br />z <br />0 <br />-a <br />� <br />m <br />� <br />_� <br />