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285 Church St, NE - Room 132 [City Seth~k <br /> <br /> BUDDING PE~ ~PLIC~ 0 V - [ [~S~ <br />CO~LE~ ~L SECTIONS 1 ~OUGH 4 ~A~IO~ CO~ <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />Mailing Address Phm~ <br /> <br />4. FEE SCHEDULE <br /> <br />I h~mby certify that the above infom~tion is correct. <br /> <br />=$ <br /> <br />Pennies are non-transferrable and expire if work is not sta~d within 1 $0 days of issuanc~ or if work is suapend~l for 180 days. <br />MC 15-73 Rev 1/95 <br /> <br />t o -Zt-/-91o <br /> <br /> <br />