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Fermi ?.a <br />•l' 1.1 <br />©CtTYOF lil: ti9.Hc)2 11CGN <br />a .yi I ant :o completcl nurnoerod spaces only. <br />l� SITE ADDRESS <br />OWNER MAlhADDRESS <br />ZIP <br />P1iONE <br />2 itidore P cTaruis -.;-33G P:iivtew Rd., V taiumtsUl.ew,Niilsrrl,. '216-SUtt 7 <br />r CUN11rAICTCR �} MAIL ADORES'S (� p qy ZIP PHONE <br />N . l .CC AC—ri ip ly CLU 1 k� �f M J.70 C. , Pe bly..N 3 a B (Qi{Rt r '.l� 51.1-1_(6. { ft/'� %3 <br />ARCHI°t•CT /Q 5I(NF 'ENGINEE.9 /J MAR.4000E5S ZIP PHONE <br />Icf 1 1111. 11111 <br />USE OF 6UILDING <br />DESCRIBE WOR <br />_ i S-*ta. C� lca-f` <br />vAL'UAT,ON ur WoFK - - - -�® <br />117.°' <br />NOTICE <br />f1E 0EP.MI' uEGQ fI S NULL ANO VOID IF WORK OR CCNSTRUCT1CN <br />AUTHORIZED I5 NOT COMMENCED WITHIN Et LAYS. OR ti: CONSTRUCTION <br />OR ! ^!ORA IS SUSPENoED OA AEAtdDQNED FOR A PERIOD OF 12D DAYS 41- <br />AN via.4E AFTER WORK 1S COMMENCED. <br />+-1ERE3Y CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION ANO KNOW THE SAME TO 0E TRUE AND CORRECT. ALL <br />P, ': lS:oN5 OF SAWS AND QR71NANCE5 r,,OVERNINO THIS TYPE OF WORK <br />'+.1LL BE cOMrtIED WITH WHETHEFI SPECIFIED HEREIN OR NCT , The <br />GRANTIN© pF A PERMIT CCES NoT PRESUME TO .LIVE AUTHORITY TO <br />'.10LATE DA CANCEL THE PRG41StON3 OF ANY OTHER STATE DR LOCAL LAW <br />me3L.LATIIIG CONSTRUCTION DF THE PERFORMANCE OF CO STRUCTION <br />III V) 97 ?/ff. <br />SIGAATU E OF CONTRACTOR CR L.THORIZED AGENT MATE) <br />.51c,N ITL:RE , F OWNER (:r= OWNER BUILDER, <br />(DATE) <br />IMPORTANT TO APPLICANT — PLEASE READ <br />:SEPARATE PERMITS REQUIRED FOR: <br />PL,;A,IE31NG +� <br />!- (EATING, VENTILATING <br />CA AIR CONDITIONING M_ <br />ELEC rRICAL <br />BLACKTCPPING # <br />SEWER h & WATER * <br />THIS IS AN APPLICATION ONLY <br />THE I'Ef =MIT WILL BE ISSUED AFTER <br />RE'SIEWAL OF THE APPI_,C.:,TION, <br />Tyte �! <br />Gxii <br />US* <br />Zos+# <br />Sr. d <br />Ihdp <br />Crootali 34.R <br />Me of <br />Srorw <br />Rau ad 7 Ye, u .N7 <br />Of, STREET PAP[('NCSP CT:S <br />u', <br />OTHER (5wdy) <br />E,A.5e+Eur1 C r.% <br />• <br />N .! ' •i, : r. 11 f' Li 11'; <br />.IN1.4'e11a sCCERISD .v <br />CoNTRACTOwS LP :EA,SEe <br />nre.a C1.4elae0 ear <br />mBr•®C�C� caa taa <br />STSTG _.___... :.f 40T UEOUIREO <br />3 pvs <br />}U1)19$ --(pi., 1 urc.,0 <br />,�A <br />3ERAearFEE <br />.vr.a cEG <br />SURC.,AFCF <br />3WM�.4'J4�F <br />- C6f�Yra C1etex. 1 j <br />rOTALFEf 1 <br />AECE'PT f <br />• <br />