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�. ._ . <br />pErwpMn <br />everett <br />BUILDING DEPARTMENT <br />26B•8746 <br />❑ DEMOLITION <br />A'�PLICATION FORC� <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />O COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br />�H�A wil�lVVn[» �r��♦ a�r rnvnc <br />pR T,:+. n�ceoAa �`1°/ RvGKFR LyNN(w�.i 9��7 �s+p-77s7 _ <br />MCNITECtORDESipNEN MML�D�RESS Cirv ZiP PnONE <br />everen <br />e� <br />OtNEMLCONTIUCTOR MMl�0�RE55 C�n' 21P PNONE UGENBE• <br />a�.� _„_�. ��.. 3s�1 Sn:�v� �cu,,eTi- 9��.01 339-SsB�' AcE�v�rsi�,�CO� <br />RUM�INOCOHiR�CTOR MM��DDNESS GiN 21P PIIONE 4CENSE� <br />1 Oi WORN <br />NEW ❑ AODIiION ❑ ALTERATION ❑ REPAIR ❑ OEMOLIT�ON ❑ WOODSiOVE/FqpL.INSERT ❑ BUILDINO RELOCATION <br />��ION OF wORlc ICOlT 01 M�IERI�L6 PlUS UBORI <br />� A w «� <br />OF BID�. <br />,+ <br />3�� <br />I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS AP <br />PLICATION ANO KN01A' TH E SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCE560VERNIN6THISTVPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEHE• <br />I N OR NOT. THE OFANTIN(3 OF A PERMIT DOES NOT PRESUME TO <br />QIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION3 OV' <br />ANY OTHEA STATE OR LOCAL LAW REGULATINQ CONSTRUGTICiN <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />516N�TURE OFCONiR�CTOR OR AJTMORIZEO A�ENT O�TE <br />X Q...., R . �..11«.�_ 57y/d-7 <br />P. <br />THIS PORTION TO BE COMPLETED BY BUILDII�lG GEPT. PERSONNEL <br />lOT <br />VAC�NT SITE <br />OVES ONO <br />NO.OF OWELlINO <br />PUN CHEGN FEE <br />FEE IRECEIPTNO. <br />fEE! � V�LUATION I FfE <br />BUIlDINO S <br />M.1M. OW. IOAD - <br />PIUMBINO <br />MECN�NICAL <br />OTMEP <br />PENALTV <br />♦PPRFORISSUA�1e'r��IW .—. <br />�" 70TI1L <br />� i � t�-tiY'r�T`'C �...1-I�7 '�S '�R� � <br />��-Lsyc� Pa� S�•�Ru �'l � <br />i _ _ ,�, -co nw.c�c �4 �v-2. F�rio�.� <br />0 <br />