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9 <br />fheEver9�een ^������T1�� ���• <br />��tt�F CONSTRUC�'iON <br />evere�t PERIv11T <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259-8745 <br />❑ COMBINATION C� BUILDING ❑ MECHANICAL ❑ PLUMBING <br />MRILAO�RESS �v<I�G�. (��l ZIP� y�VN. PII01lE <br />[s 7i3 S.c. ,�c�e,c�.—/ ��a// cc�vv � i <br />nr_m <br />ZIP Pi�011E <br />evcrcll <br />� <br />❑ SIGN <br />GENERALCONTRACTOR MAILAODPESS Cltt ZiP Fl101i[ IICENS'c• <br />l U _ G/� ^ C�N -/! �/'f.JL. <br />5_i4F�1� //N � P'C3� G 33��'G.S�do <br />MECIIANIGRLCONTRACTOq AIRILA�DflEiS GITY ZIP PIIOII[ IICEIISE• <br />PLl1A1BINGCONTRaC'OP M4ILAOORESS f.li: 21P PIIOIlE IICEIlSE• <br />I�. NEW 1� ADDITION ❑ ALTERATION ❑ REPAIR ❑ f7EMOLITION ❑ WOODSTOVC/FRPL.INSERT ❑ BUILDING RELOCATION <br />VR•�LURTIO/N GF WO�flN)�C�OaST OF 1.IRTEPIAI S PWS 1R90P� <br />/ /� I�VT/ .- <br />�ESCRIUE \'fOaK <br />7U/ �I , <br />❑SE OF BllIL01MG <br />�..,L,�<. <br />ior c.. _o�octi— <br />PROJ[CTBOORE55 <br />/ 1 4/ (/ ( <br />d v,�l -L <br />=,5. ��; i � <br />PE9TYISH NBELOWOii <br />KITCHEN SINN fl <br />vy <br />� <br />I IiEREBY CERTIFY TfiAT I HAVE READ AND EXAMINED THIS AP• <br />PLIC�TION AND KNOW TIiE SAME TO aETHUE AND CORRFCT. ALL <br />�./ PRUVISIONSOFLAWSANDORDINANCESGOVERNINGTrIISTYPE <br />�� 7 OF WORK WILL BE COMPLETED WITI-I VJIiC-THERSPECIFiED FIERE- <br />- INOR�OT.TI-IEGRANTINGOFAPERMII'DOEStJOTPFiESUMETO <br />GIVE AUTIIORGY TO VIOLATE OR CANCEL THE PROJISIONS O� <br />ANYOTHLR STATE OR LOCAI LAW REGULATINGC:NSTflUCTION <br />OR TI1E PERFORMANCE Of COIJSTRUCTIGN. <br />SIGNATURLOFCON7RAC70RORAUTMORIZGDAGENT Oaic' <br />" ���,' �. /�'- � �,� <br />NPPLICANT9CIiYf1115111CS5LIf,Et 11 <br />,�, (�. �vc.-cGY <br />IIEATERS--DS.U. <br />I100D <br />EA <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />JSE20� LOT<REA`J <br />Pi' 1 �{240 '.c <br />fYPE OF LONSi. OCCUPRNCY GPOUP <br />y-1J P,-3 M-1 <br />iIZEOFBL�G. NOAFStORIES <br />t�� R-3. S�S M•t ! <br />APPLICATIOHACG 9Y IPLnNS <br />M� <br />J�� <br />VALANTSRE <br />UY[5 [JNO <br />I CIIECN NIIMOEF <br />��p� 1 (n I C <br />euaou+c <br />PWIADING <br />MECHANIGAL <br />OTMER <br />PENALTY <br />TOTAL <br />FEES <br />PLAI! CHECK FLt <br />FEE - Blf.11Yl b0. ��� �. (� �+ - <br />r�;i°� (�:� ,� .� ! 'i :i <br />VALIIATION FEE � <br />no � 3 <br />