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APPLICATION F�IR <br />tn�E�+rymn CONSTRUCT10�1 <br />cm or <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />.veren <br />e <br />BUILDING DEPT. <br />259•8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAiLp�DRE55 Gltt :IP FHONE <br />-r. . C�_,fl,. �'a,n a_ %�>h r�v EdcrCi% 98,tc�3 251 2y/� <br />ARCNITECTOROESIGNER '^^"^""^"" <br />J�II)%E CITM Zlp PNONE UCENSE ♦ <br />4ENER-.GONTflACTOR MAILAD^RESS <br />MEGNANIC�LLONTRAGTOq M�ILAODRESS CItY 2iP PIION[ LICENSE• <br />PLUMBINQCONTR�CtOR MAiI BDOR[55 CIiY ZiP P�ION[ IILENSE � <br />CLASS OF WOFK <br />� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ OEMOLITION ❑ WOODSTOVE/FRPL.INSERT BUILDING RELOCATION <br />W WATION OF WOPK�COSTOF MATERULS PLUS LRUORI <br />' U U00 <br />OESLRIBE WORK r <br />/' _ ... . . .�.T�. .. ./ OT h//-i.I/ 5�l Q� _ <br />Use or nwwmu ( <br />J �l o f � A r�l Q � P �- .S <br />LE6ALJESCRIPTIONOFPROPERTYI�OWNB L0IVORATTI <br />LOT_ BLOG�-OF <br />Low�►I u� v A P14r <br />L3 N( a n 7 D- e � l- �, i cs <br />$ „ZJ�i of (_rl <br />anaeer �ooness <br />�/3 � �' S . �I >/, t� L. <br />PLUMBIN6 ' <br />un TYPE OF FI%TURE _ <br />rnoHT <br />512F OF <br />NHING <br />'F <br />-� <br />vcr <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BETRUEAND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCESGOVERNINGTHISTYPE <br />OF WORK WILL BE COMPLETED WITH WIiETHEFi SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR ThIE PERFORMANCE OF CONSTRUCTION. <br />SIGNN7URE OF LONTRFCTON OR AU711 RIZED AGGNT ❑ATE <br />i� nii � w .L'li/10.v�A/1 <br />AIRCOND UNITS-M.P. <br />H P. <br />T <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />ETO�CK REARSET�ncn <br />:p 20 <br />E LOTAR A•, <br />�_Z YOD <br />� <br />CONS OLCUPANCYGR011P <br />_rj � M_ � <br />o�oc NO.OFSTORI[S <br />C,t7 � 2 <br />BY <br />Nl, M. <br />cfEf <br />BY <br />VPC�NT SITE <br />❑Y[5 xINO <br />NO.OF �W[LUNO UNIT9 <br />i <br />rA�x.occ' �1o�o <br />/�/ r � • <br />APPR fOR ISSUANCE OV <br />G -�� <br />PI.AN CIItCn'�on�uv� <br />&5 5 13 Co FEt cT�.33 �«t��.�o _ <br />� / <br />FFES VALU�TION FEE <br />ow�oiNo ��/�(l � <br />PLUMBING <br />MECHANICAL <br />OTMER <br />PENALTY <br />TOTRL (� <br />�TAP.�+.e6E. To 'pE �TtL6Z�t.�D �� <br />ti.1elJ '�U.si.v��IC.�rsl4�+tt�2�fAL <br />Uses . ��v� �ie� �v F3� F�+�G <br />-gTP,r�J>rirc t`jr.�L1!� <br />