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<br /> CfTY C}�EVERETT PERMIT SERi�'[�E5
<br /> 32�Q�EQAR�TREE7`, E1/ERE7T,1lUA�82�t�
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<br /> BUt�D111E+i�7YP�: l'�SFR D�i"ACW�p C�SFf�-,�l't I'ACHEI� Ll E�UPL.�X �1 UI»7'I��AM3LY w� UNIT�: CI C�MM�Ft�iAL
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<br /> OWNER MA[UNG ADDRESS: srx�r Z��'��<- ���� �f1(,�
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<br /> � PRIMARY CON7A�T. Q QVSlNER i�°CONTRAC7QR II{77HER:(Pi�ase Sp$c�f'y) _ :
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<br /> A�R�M�T h�re6p r;sr�!'tythaf lhave ngad and eneamFned fhd�apnhca#lor►�nrf kn�+fhe�e fa be truc�and cerrreet.Atd pl�utstons vftaws and ordlraances govemlttg this
<br /> iypQ of work wr71`be r�mplated wheGherspec/fied herein�rnof. �"he gFenffng of apemrlE dcsast�ot presume to g�re�uflte,n7yhr ukaTste orcancalthe provPsions o€any otharstafe vr :
<br /> bt�tlawragcrl8tuzg s�nstrrtcfion orfhe peHnrmanae ofconsfrucstinn. 7'hett am auHtorized byfhe oWrreYaf tftts pra,��'Y�F�rTcrrrFt the wor/rtor vuhkih appllcatlo»/s rrtade end i
<br /> cornply with Fh�Slate Cvvi�frach>rsiaw 18.2T t�GWar�d296.8t7t}(N.4C. ;
<br /> C)fyef�Vareff t�i�lcial Use Qnty '
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<br /> Dwn r/ tiior�zed Agerit S3gnaEure Dat� (Revfsed lDF12�t��5}
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