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� <br />IMEraO�„� �PPLICATION FOItJ <br />�^°f CONSTRUCTION <br />ewerel`t PERMIT <br />BUI�DING DEPA�9TMENT <br />259�8745 TO BE COMPLETED IN IIJK - PL.EASE PRINT <br />ererell <br />� <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />(1WNLI1 Y�11 �IIfIfICSV r��v �.� �.._.._ <br />MECH�NIC�ICONIR�CTqq M�IlA00FEIIS <br />❑ NEW ❑ ADDITION ❑ AL7ERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSEFT ❑ BU�LDING REIOCA�I7N <br />��IW��ONOfWORN�W510lMAIEIII�LSPLU9UB0111 � — <br />�' ATCi�TI � '�7 �� Di9� • •� <br />LOt—Bl0(:IL_ <br />� <br />DISP. <br />iRAV <br />I HEREBY CEtiTIFY THA'i HAVE READ AfJD EXAMINED THIS AP• <br />PLICATIONAND KNOW THE SAME TO BE TRUEANDCORRECT.ALL <br />PROVISIONSOF LAWSAND ORDINANCES(30VERNIN(i THI3TYPE <br />OF WORK WILL BE COMPLETED WITH WHEiHEq SPECIFIED k1ERE- <br />IN OR NO?. THE CRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE f•ROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAVJ FECULATING CONSTRUCTION <br />OR THE PERFORMAMCE OF CONSTRUCTION. <br />SI�NATUREOFCON RACTORORAUiHOP12E AGENt DAIE <br />X . ��, n w .. ��.fL.� / � .. <br />THIS PORTlON TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />fRONISEiB�CN IiE�H5E)IBACN SIOE9EI9AGK PUNCNECNNUMBER �••G�ECMiEE <br />�.i/ I [�-��f� I �� / O�/�� •i �-7 iEE ���L�S 4^ECEIPiNO. %.i,���.• <br />I <br />lISE /ZO�NE LPI I111E� Y� �� w�� ��� � � � V � <br />11— I 4'*ES C1N0 FEE9 v_ VALUIITION FEE �__ <br />�� 1�_ \ <br />r B�op a y ` No or stbniE9 <br />. : YV[1 � <br />PUNS GIIEGNED BY <br />I <br />M�R OCC. LO�D <br />fOR <br />BUILOINO <br />vwMeino <br />MECHRNIC�I <br />OTHEfl <br />PENqLiY <br />TOTAI <br />S <br />L�1J <br />