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Jul 14 03 04: 5zp Serving The Environment 7634783612 p. 2 <br /> Jut-11-t003 02:iZpn Fro�-CifY Of 0ltON0 ♦i5221i1616 T-B21 P.002/003 F91a <br /> Torai Fee: S 5 Q '� U Date kceceivea: <br /> Pemiit�: <br /> Entercd By. r'P�rUv�ak. .. . <br /> .,� �_ - . . <br /> __�'i�`�O�'O�tONU -��G P'E�T APPI.rICATION <br /> All information must b�sub�a rint aIl inf+ornmtion�revicw wwll be started. <br /> (A p <br /> "�"""�"M�_��T� ' ��R�plc CON'TRACTOR . <br /> THE ApP'LICANT IS: {circle one) . <br /> aos srr�AnnxEss: t 8� � -� 5-� �- <br /> �(� ZIP: �S 5 3G( 1 <br /> �l���;Q � �1 ,� psor�: c��� °��a � � 3_ b��`� <br /> NAME OF OWNEIL•_ (worl� <br /> MpII,ING ADDItFrS5;�...r� n`�a�v�- CTTY: ��S�I <br /> Gr� P'HONE: 7G 3- 'f2 l =3r1 I�o <br /> co�"e�rox: _Ga T,�,,ab�.�� _ <br /> C4NTACT PERSON: MOBYLE/P, ��+t: <br /> Il�TG ADDYtESSi -�� , �CITY•��l �t'� ZIP: S� 5�_� <br /> MAII� <br /> STATE LICENSE: � � _ <br /> �wrirrhit� `�"'��'(����I1. (�O�SKL� �h'�_���� 3' `�D��`�T" <br /> MA,II�IGp�DRESS: .,�.� CTTY: t��- _ <br /> NAl11�IE. �.�dr+�l ".. ' �'' RF•GXS�RATION� <br /> '!'YpE OF'WORK: New Addition_J Aocessory Suuct�we <br /> Move - ��m��Alteration La�Alteratlon <br /> pxoros-�wox�t����� _.���� a-+�w�.�d <br /> � s o �`� <br /> sro�s: � sQ.�r oF�.cx�ooR: <br /> NO.OF B�DROOMS: <br /> GARAGE STALLS: A'TT._....,._ DET.� <br /> �'�IlVip'I'ED C4NSTRUCI'YON VALUATION(e�ctuding 1an�: � o�' 'x' �`�`'� <br /> I hercby apply for a buiiding permit aacl I acl�wlcdgo tl�at the infoaaarion abovc is comPle�and <br /> axurate� that the work will be i�n confotmaaoe with the ordinasrces aad oodes of the City anc!wid► <br /> the Scste Building Coda: tbat I undustand tbis is not a pe�i��cdW la�,is not to start without e <br /> p�rmit; a�yd tbat c6e work wilt be in a�cord c'with aPP P <br /> APP�.I <br /> CArt'1''S SYGNAT�3YtE: � ��� ATE: ` � <br /> NOT�EI ».,.,nde of Aa�sre�es rrquin separiate pern+it app by Police Depa�t�tt a�d <br /> Ci�y Corniat 60 days prior to the ev«t. Non parm�tted e►'erets n'ili not be alrowe� <br /> a�C � a � S S(� e a1 Q� w�\�, <br /> � <br /> � .- I`1 � U � <br /> � <br /> C.`� l9 �w�'" U,,�eti �'�Gr�y <br />