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a�'.�:, ., ' iY '7� <br />5 ' �PLICATION �OR"" <br />��� "'" CONSTRUC�IQN . <br />everett P��tMll' <br />BUILDIPIG DEPARTMENT <br />2b9•8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />QDEfAOLITION , ; "+ ❑ COMBIVATION � BUILDING �i] MECHANICAL '. <br />� OWNER MN . /.DORESB . GITY . ZIP• !� <br />' rl1 n. .. �- IZ i�.... �.... � %G,�20 /.+ �4�L��. i%:,. d..'l� .S�I,:n.,.:.n.�i' i 4J�,51 <br />IC�rI V1� VCO�vnc��. V•. . 1 <br />.. .. . ' , �... . <br />9ALGONTRACTOP� ' . 1 <br />, _, <br />� PLUMBINfi <br />��:�� <br />PNONE <br />PHONE <br />—� <br />evercn I <br />e <br />❑ SIQN I <br />� �il.l)YlE'r�. ,\ � - <br />I��MECMIJiIC�LCONTMCT03` MAll�O0RE9S Cltt 21P PMONE LICEN9E• <br />i : <br />i_ KUMlINOCONTR�CTOR MAILAUORESS -� �� Cltt ,ZIP PNONE , UCEN9E• <br />� <br />ClA!! OF WORK <br />�� ryEyV ❑ ADDITION ❑ AL]ERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ B�iLDINO RELOCATION <br />i ��_sr.:..wcv• <br />�..' DE4CP18E WORN <br />� �111i��•vv�•� ��.V�.�u_ <br />� �� UiE OF� ' <br />�: . , i <br />'f' l[OAL OEBCRIPfION OF PROPERTY�BNOWN BELOW OR ATTACN FOUR GOI <br />. . � . \ i , .� 1 <br />�" lZlo <br />a <br />� <br />I HEREBY CERTIFY THAT I FIAVE READ AND EXAMINED THIS AR <br />PLICATI �N AND KNOW TH E SAME TO BE TRUF AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES OUVERNING THISTYPE <br />OF WORK WILL BE COMP'_ETED WITH WHETHERSoECIFIED HEiiE- <br />IN Oq NOT. THE GRANTIN6 OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� <br />ANYOTHERSTATEORL CALIAWRE6ULATINGCONSTRUCTION <br />OR 7HE PERFORMAN OF CONSTRUCTION. <br />SIONATUREOFCONTRA RO�AUTMORIZEUAOENT D�TE ', <br />.� <br />��� tL/ � / �tI /_ L✓ / �/5 �G 7 li <br />AVPLICANiS CITY BUSINESS IICENSE N <br />. � , ,;.,, . ;• . <br />0 <br />THIS PORTION TO BE COMPLETED BY BUILJING DEPT. PERSONNEL <br />�� FRONTBETBACK <br />�,. UK iONE?s , <br />;31�4;:i�,. f(• J <br />� �. <br />f <br />.iJ� �. <br />li APEA <br />�/� 393 <br />:CUPANCV 6R011 <br />R-3 <br />SCHECKEDBY <br />/�N <br />7�S' <br />ONO <br />UY ELlINO UNIT9 <br />1 <br />L ' f_ . <br />C� /�� /: � FEE ��I� 1�' PECEIPI NO. �?�[au <br />Q �� OL J i a+ <br />F[F! VALUATION FF� <br />/ <br />euamNa i s <br />PLUMBINO <br />MECMIINICAL <br />OTNER � <br />PEN�LTY 1 <br />TOTAL <br />ass . <br />�.�,�.:,....._......._.......R._.__M_.�,�_.,..,.,.�:.�.:. _.,..- -_:�.,:� � <br />,5:...S��t'.': raY^��II'n•..�.-Z�... ��..� ...�. .::T���'�I��....... .} �i.y:..^. �'�.i. <br />