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--� °'. ,PPLICATION FO►_' �,Cte„ <br />everett CON�3�RUiTTIOf� 0 <br />CItY OF <br />PE M <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUiLDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNEP MAitA00RE55 �. OTY ZIP PHONE <br />%�i�/v>" �'i°i�,�•:.�' `�� G, /_/G��r. S E. G�<.?„�r;� cv.� 9y�"i � S 3 Jv�i 1 <br />�PCHIIECIOROES�ONEP MRILp00BES5 CIIV 21P �110NE <br />OENEMLCONIMC100 � M�IL��9l1E59 iG�JY�Ir�.Y �2��C>u VMUNE LiCE115E• <br />-/'iUi�-'ti C."USla�.ci fr'�,NL 7i3 S.� E�r�r;r ,f /i �u.+� 3{"; ,G:S�'� G�—U,���// <br />MECN�NIWIGON�R1LiOq ����LROOtIG53 CIiV � ZIP PFONE UCENSE�,/� <br />�"�%y <br />0�(�MBINOLONiR�C10R MMLADDRE59 CITV ZIP PIIONE lICE16F• <br />C1L�l.9/5 OF WORR <br />11d NEW ❑ ADDI710N ❑ AL7ERATION ❑ REPAIR CI DEMOLITION ❑ WOOD3TOVE/FRPL.INSERT ❑ BUILDING REI.00ATION <br />VAWAiIpNOiWOf1N�W51011,1A1CRI�LSPWSLI�OR1 � ' <br />U � <br />oescn�eE wonK <br />,�,, : i,l � i,./�,,.� �-e c <br />�Pi <br />J OF <br />/ �S 1 HEPEBY CERTIFY THAT I hiAVE READ AND EXAMINED THIS �P• <br />PIICATION AND KNOW THE SAMETO BE TRUE AND CORRECi. ALL <br />)tVORR1tACHFOURLOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTNISTYPE <br />w ��v >� � OFWORKWILL6ECOMPLETEDWITHWFIETHERSPECIFIEDHEHE• <br />IN OR NOT. THEGRANTING OFA PERMITDOES NOT PFESUME TO <br />GIVE AUTFIORITY TO VIOLATE OR CANCEI TI1E PRUVISIONS OF <br />ANY OTFIER STATE OR LOCAL lAW REGULATING CON57RUCTION <br />OR THE PERFORMAN.;E OF CONSTRUCTION. <br />SIGNATUREOFCONIRACWRORAUTHORIZEOAGENi DA7E <br />;yr'�.-� �I /� �. „ G - 3 - s C <br />� •''s�-G �.. Y/��P S{`, E<.e,oei7 <br />LAUNOflYTRAV <br />CLOTHES WASHER <br />WA7Efl HEATER <br />URINAL <br />Of71NKING FOUNTAIN <br />3 <br />,26 <br />iE 20NE <br />/� - � <br />�PE Of C0�lSi'r <br />�N <br />]E Of OIOG <br />�20 / Oilh <br />AIR <br />UNIi <br />HUOD <br />THIS PORTION TO BE COMPLETED BY BUILDING DrPT. PERSONNEL <br />FEAF SE1BAf,H £IDE SEiBPCN / PLAN CHECR NUMBER �14N GIECR fEE <br />o'f(J �a b �r� /� ^�/� fEE �j�-��� �ECEIPTNO .. <br />LOiABEA /% - �l <br />VACFNL SIIF. FEES �A�URT�ON FEE <br />�57U �i'ES ONO <br />OCCUPANCYG�OUP NOOFpWF.lLINOUNIiS <br />R� < <br />/ <br />` NO Of SIUmE <br />✓ �� / <br />"OlI�q110±Af,' Bv P�AHSCHECNEDBY APPpFORISSUANCEBY <br />i'�� /i �. ��. L. ; G, <br />BUILOINC. <br />PLUAI�ING <br />h1ECHANICAL <br />OTNER <br />PENALTV C7 <br />TOTAL <br />