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0 <br />�'��a <br />Q APPLfCAT10N �� `" <br />« �«"'"" . CONSTRUCT101� , '`� eYeK„ <br />eVerett PERMIT e � <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDINQ DEPT. <br />269�6746� �] COMBINATION � BUILDINO ❑ MECHANICAL. ❑ PLUAIBINO ❑ SION <br />� <br />p�yq�p MAILADORE&7 _ CITY 21P . PHONE � <br />T t /_ /'��.���/^:�T _ iJ A. ��.i nw ,C"J___�J_. .'•4tn�n � 77e��/1/ � •, ;r?� <br />e <br />21P <br />21P <br />PLUMBINOCONTMCTOR , M�ILA�GRf95 CIIY 21P PHONE LICEN9E• I <br />I OF WORK <br />NEy/ ❑ ADDITION ❑ ALTERATION CI REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDINO RELOCATION <br />�a�� ��o. <br />0[lCRIlEY/ORN • ' � <br />. .� _. — �. •I wy. / 1 �' ' _ '/ 1 l/ e��_.'__ <br />, • , <br />c <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TH13 AF. <br />PLICATION AND KNOW TH E SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAW3AN0ORD'�ANCESOOVERNINOTHISTYPE <br />OF WORK WILL BE COMPLETED W ITH WHETHER SPECIFIED HERE <br />IN OR NOT. THE GRANTING OFA PERMIT DOES NOT PRESUME TO <br />61VE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� <br />ANYOTHER STATE OR LOGAL LAW RE6ULATINCi CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCnON. <br />81ONATURE OF CONTRACTOR OR AUTMORIZED AOENT' DATE � <br />X 1l�<� ./i � G, -/a - .�r� <br />IPPLIC� iBC1T70USINE9SlICEN9EN0. —T <br />THIS ?ORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />'1� 2i <br />UDEZONE _ LOTAREA <br />R-5. 3a,' <br />TYPEOFCONSL OCCUPANCY <br />��� 2� <br />812EOFBL00' NO.OFBTOR <br />�b'?3 SF 2+ t3 <br />u <br />PLANSCNECKEDB <br />J� <br />:i <br />PLAN CMECK Nt1MBER Li� <br />, [�.%/I�/ / % FEE TO / ' I <br />VACANT SITE <br />pYlS ONO <br />OGC LOA <br />�� <br />i. FOR IS9U�NCE BY <br />L•C <br />FEFt I V11LU�TION I IE[ <br />BUILDINO <br />PIUMBINd <br />MECMANICAL <br />OTNER <br />PENAIiV <br />TOT�L <br />�!o gu�u� �,c�y ��c.cr � <br />ZS ��'. 1�0�6 'F'E-►� Av�.—�X.��' <br />Fl .��1 n-tt nti1 ot- �n+E Pa�+'r <br />e P tt•� �'�,U.u7 c rv4. � 4� 2. Olo E'�e. <br />_ _ , •:.... ..r '._ir , - . >: ;-� <br />