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. .PPLICATION FO�. ` <br />IMEwrprN^ CO N ST R U CT 1 O N <br />urr or <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLIT�ON jI(%COMBINATION ❑ BUILDING ❑ MECHANICAL <br />�WNEP M�•II�DOPE53 GIiY 21P <br />l�v�✓1,.�, f.S„s �,.�f �;R a?ia i.3�''/°l_,I, <r! LyM., »�u� k.� <br />❑ PLUMBING ❑ SIGN <br />PNONE <br />>J?��7 %�.fy7c1'� <br />_a �i,.� _ <br />GENER�LCONTR�CWB MAILAOpRE55 GIIY ZIP PNONE � LICENSE• <br />.�;� 1.vC7ro.t c� 5�S«� 7 <br />MECM�NIUL CONTP�CTOq MMl �D�HESS CITY ZIP PHONE LiLENSE • <br />❑ NEW <br />1E0.1L OESCNIPTIOM OFPR <br />ioT �aioc�— <br />� � <br />L� : %�1.. <br />M�IL <br />y.N-� . �/�'iCrJ(//iKt <br />❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCRTION <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS AP• <br />�^L PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br />OWNBEIOWON�TTAGMFOURCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVEFNINGTHISTYPE <br />`��� OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GFANTING OFA PERMITDOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />S� �`O�S ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNRTUREOFCONTFACTOflORAUTMORIZEO�GENT DATE <br />V �h�L+'h f.i�Jrf ��,.f f'{.�—� i/2 J�cY� <br />,� �nviC�sciT e�easuc se'�io.� b, <br />�/� �j� : <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />�J/ <br />OF CONSi <br />� � ��I <br />JF BIDG <br />� k�J � �' <br />V • ` � ' 1 <br />� V � <br />//, y��9 � <br />OCCUPeNCYG00UP <br />\�' ... <br />ND OF STORIES <br />NS CNECNED BY <br />/. �i <br />� �� �.- <br />� <br />V�CANI SITE <br />QYES pN0 <br />��� <br />BUILDINO <br />PLUMBING <br />MEGM�NICAL <br />OTHER <br />PEN�LTY <br />TOT�L <br />��I IFEE24�,�lAELEiPTNO �p� <br />�P � Q� <br />fEE! V�LUATIOM FfE � <br />