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x r'� <br />;D�x <br />�' H <br />aycn <br />H 93 <br />y Z r-+ <br />KH� <br />O HO <br />cn H <br />C7 O t7 <br />H C7 <br />OH <br />77 C] C7 <br />H C] O <br />C,� e C] <br />a r�3 .�-7 <br />C Z <br />r+ H <br />O�H <br />� i� cn <br />��� <br />z y v� <br />ti o cn <br />e"'° � <br />�.:. ,.! <br />�-- ..'s <br />� <br />. �PPLiCATlON FQ�\ evcrelt <br />`°"f".`'"°°° COR�STRUCTION 0 <br />��n oF <br />�verett PERMIT <br />BUI�DING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />..,.u�n � a-! .. unii noor+es. ari air a��orre <br />1�I � l � '1 !, � �- � i. <br />.. nrccroaoesouEa rnoi�noorvess � cirr iiv onar�E <br />�;i�( '���I:�"�, � .�1'��, � �;I <br />i�.r.!:PPLCOMRACiOR _� �AqILA0�RE55 QtV ZIP FHONE I.ICENSEa <br />!! CIIRulC,4 GONLRACTOq 4nIL qpOflE$$ CIIV IIp PIIONF LICENSE + <br />vW'AO�NGCONiPaC10R MniLnpUvt]s an IIP PIIDNE <br />O NEW ❑ ADDITION ❑ ALTERATION O REPAIR ❑ DEIdOLITION ❑ WOOOSTOVE/FflPL.INSERT ❑ BUIL�ING RELOCATIO�� <br />l'�WFt10NOG\VO�IN�COSiO�fAA'EPoALSPLUSLABON� _ . � . � ., <br />'`: '� 7'��: i11G(I�.l;i- <br />;;�,ca�eewouK _ t � <br />� ILi( �1111f `�.�11 I� _ <br />�+i or euunn+a , i <br />i i����i oe�rnianon o� PAoa[n.visNowr. <br />�.��,�—o�oc�—o� <br />f � ,��f Ci ACOHESS <br />I I I � �- ' <br />I HEHEEY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATIONAND KNOW THESAMET08ETRUEANDCORRECT.ALL <br />PROVI;iIbNSOF LA'NSANDGRDINANCESGOVERNINGTHISTYP[ <br />OF WORK WILL BE rph�pLETED WITH WHETHER SPECIFIED HERE� <br />IN OR NOT. THE GR4NTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORffY Tp VIOLATE OR CANCEL THE PRO:'ISIONS pF <br />ANY OTHER STATE OR LOCAL LAN' REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />S�GNaillqE O� CO'rtr�qC'OR G� AUn�pmZED n�ENi D>tE <br />X <br />��J .I./L��._. <br />,GFLICLiLSCIIVpU51!IESSLICENSENo r <br />AI{� <br />U M <br />M <br />SUB TOTAL _ �1 SU� TOTAL _ S _r <br />PEHMIT S—�—. I PEHMIT 5 I <br />TOTAL FGE � _--- S__ _I____ � "_' __ TOTA� FEE _ 5 r <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />��� RUIlS�EI�p/n yIpE5Ct0oCr: PL4NCMCCNNUIdppl � p�qNPQCeFLt <br />•� � � � t LFL I (��I rI � RECEIP� Np�� �� �: ' <br />u'..,t:[)N�� VJiFRFP VAC�NLSi1F'y. ���-�— - <br />Q^rlb FEES VRLURTION FEE <br />i��'[ OfCOi�Si <br />¢� � <br />,i.l p1 nloG 1 <br />� <br />.�� � . � .i.IlOf1 nCG OV <br />1,�� <br />�� � I]TES �. <br />OCCU�PA/N/CYf.�OUP NOOfDJW�FLIi�N(:Utii�� <br />/ �/ � / —�/ <br />NO Of 510R�E5 IAA% OCCyI�OaU <br />/ �l <br />'li f OH ISSU4�iC1�. Pv <br />L, � • <br />pl1ILDING <br />PWMpiNG <br />tA[CMANICAL <br />OTNER <br />PENALTY <br />TOTAL <br />S <br />