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APPLICATI� FOR CONSTRtqCT�N PERMIT � <br />TO BE C 1PLETED IN BLACK INK—PLEASE PRI <br />�UILDING DEPARTMENT CHEATING SVSTEM: �, GAS ❑ ELECTRIC U <br />259 0810 <br />i I DEMOLITION ❑ COMBINATION I I BUILDING I i MECHANICAL I�I PLUMBING ❑ SIGN <br />ONN[N 4�l.b�NC55 GfY I�C p1pME <br />{^,:,,..i• '?c1G .1��/i7 ;L"i1�,�-4= �..�c.=� r.�lor� 33�_; g��. <br />+n+.ru wewaaas arv nr r��e <br />/.f'�imf[C}011D[SK.HkO YAhApONE55 [liv bp P�qPE <br />!-�laui Cr"�=r� 2��3 R<.•.•e(�ri/•�'��;r-if" ��„7oi �.-�_.:•/;i <br />Qh(14lCCNiq�C10F � M/.4�OOPE55 �ItY IIP VrKK1E SiA1ElK,�,F�H{SE�•���/� � <br />i)i!.��' %4.=i E ln.,..T 1. �.i..1� A� �o J r2 J,i��-�LIa'n 4+rJt- <br />.,u�VUUILMiIMCiOR WiIA�DFE55 Qtt IiV V�qnE 54fELKCNSE• <br />•��� �'I:iN Y�R�DORFSti G�Y jlp p11QN[ Si11f11fFUGF� <br />i. n�111�1C1 �X4'( 0{ VfJll�t <br />i`�f ��'i �� _ <br />i i un6 v: "in :.•� . �.� � v•�U up'IXVEO <br />� ��n'(1S[0 USE IX BUM1DNf <br />� i ru ttscnn.uoxw vmv[nnrnroxveem <br />u.�_ � &oc. w <br />9 <br />`� � <br />_ _ �� � �- — <br />, eo:.c� uv i o �+uveen <br />.i.nin�cixv�ion„�er�oin.woncss.iucrHa+cxuuoEn — <br />WATER CLOSET <br />SINK � <br />rEnn� <br />- - � ------- TOTAI <br />FOR OFFICE USE ONLY: <br />��_�iS1111�:n � 4l�H�CfO�CR <br />� -� i rr � <br />--v.r_—_ l /�% <br />� .dGi � { ia�enu <br />� –1 <br />., �.� ���5 � ,,J� <br />JL.N-- - � <br />,n �.�� o . � nntsrniv+iu�sr o0 <br />�>>6�fi� .S.i <br />�... � �I��.Y 1 O�0 I IIIC M�f1M P(O C <br />s�oe si �o�� -- <br />Cp11�Ci PLNSCN AND PI�CNF Ip <br />�I NEREOV CEHTIF/ iHAT I HAVE REAO AND EXAMINED THIS <br />APPLICATION AND KNOW TME SAM[ TO O[ TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND OROVIFNC[S GOVERNING THIS TYPE OF <br />WORH YlILL BE COMPLETED WIiN WNEfHER SPECIFlED HEFEIN OR <br />NOT. THE C.RANTING OF A PERMIi DOES NOT PRESUME TO GIVE <br />AUTHOFiITY TO VIOLATE OR CANCEL THE PliOVIS10NS OF ANY <br />OTIIEfl STATE OR LOC�L LA\Y REGUTAiING CONSTRULTICN Oq THE <br />PERFORMANCE OF GONSTRUCTION. THAT I Ahl AUTMORIZED BY TME <br />OWNER OF THIS PROPERTY i0 PERFORA7 THE WORN FOR WHICM <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTqqCTORS LAW 1 B27 RC W FND 29G 200 W�C <br />x-�"��i " �� a��- <br />PANGEHOOD <br />U. M <br />I'�. VES NO nunoiKG <br />—. , ..- ---- - — <br />�.'"�� � Z rwuoum -- <br />B1 [I,INI � Mf.CN�NIG�I <br />I �� YES ✓NO — -- <br />nkrc:in�Mrt��idi / — AOpIOON�IPtANC9ELN <br />�� —__. -- <br />OIIICR <br />SIAI[ II111101pG SII9C11ARGC <br />` I a[euore�o <br />131, `l33 I---�J " � <br />iai� �;, <br />�.J ) .. - � <br />. i.. � �.n.,r.ruounu. �I —_____—" _ "_ _ .-- _'.. <br />CIfYOFCVEflETT runi�r.�vonKs <br />LOCALSFLES <br />� n��r �/ � � TA%CO�EIS3105 rorni <br />__. . _l`1.1L_ __—____— _ <br />�r �� <br />� � y.1.7 <br />/.?-1 / , � � "1 <br />