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,�„�„�, "�APPLICATION F(^ R <br />everett CONP RM TTION <br />evercH <br />e <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259•8745 B COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBIP�G ❑ SIGN <br />OWNER� M�IL��DRE55 C�iV li� �'��ON[ <br />�i�i.au �. ,4i� . /� �n7 //lor�� �1.� .t3r�7�,/r.7G u,•A. ��.4c,i/ �f ii ��.= 77 . <br />♦RGHITEGTOFUESIONER M�ILAD�RESS CIiP lIP PI�ONL /7�/ ��ZO <br />_` <br />�Soti� L2/(�f, A�Z�i/it�75 922� G''N/Jt:�E.%, c: I���� 5 L�EY �G<7 �/,Kx^5 /G35 <br />OENEIUICONTF� OR M�ILApDRE55 C�iv IIP �✓S `{S(}OIC�,� LiCENS[• <br />ra.�, co,c.s✓� �.o-��i�, ���o� �ic:�� P� �t.�. �;�;f��� cc�i �isnii � TNR �7Gj/l�7G <br />GIfV ZIV PIIONC <br />PLUM�INOCONTPI1GTOq MML�DORE55 Cliv 21P VIIONE UCFNSE• <br />GUSS OF WORN <br />I�, NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION" ❑ WUODSTOVE/FRPL.INSERi ❑ BUILDING RELOCATION <br />Vs W �TIOH Oi WORR (Cq9T OF M�TEHIALS PW9 L�BOPo <br />3`�L��OOO. � ^ �3O_C`�L�O �'CJ <br />DESCNIlE WOPR ' <br />/� � %n �/'iC-`Y i V�' � — -3 �ii7�/?�/ �''i/ /.�ii i <br />�ot— <br />D7 <br />/O � <br />U3E20NE <br />R- � <br />ttPE OF CONST. <br />-za-s <br />iR�V <br />FOLIi COPiCS� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUEANDCORRECT. AlL <br />PROVISIONS OF LAWSAND ORDINANCESGOVERNING THISTVPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIF�EDliERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STAiE OR LOCAL LAW REGULATING CONSTRUCTION <br />OH THE P RFCRMANCE OF CONSTRUCTION. <br />9GNATlIRE pN1APf.lOf10f1�U711UN12C0Aff.Ni UAiE <br />' X V I ��-1 )—�,�}� ia __� � r <br />r.r.a <br />P. <br />GAS FIREO � C. UNIiS-TONNAGE <br />� <br />M[TAL FIRFPLACE 8 CHIMNEV <br />WOODS70VEiFIREPLACEINSGHI <br />_' 1 _— CY�J <br />__'._ "_ PERMIT __'___ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />� <br />V� <br />BY <br />T �� <br />V�CANt SIfE <br />SF �,.ES �+- <br />NO OF DWELLING UNIiS <br />L �� <br />c /���-�� o <br />s :� �� <br />FE[9 <br />BUIL�INU <br />PLUMUING <br />MCLIIANIGAL --- <br />O111GR <br />PENn1.7V <br />TUTI.L — _ <br />���.-„� :,.��� <br />fEE�7.2./1 z li q� i�l'�„4.' - J <br />t. — . �) :.� ��?j <br />VRl11ATWN _� -� — FGE � ---' <br />__._'_"__'.j—__ I <br />_ C�'SS�W <br />