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07/11/2022 15:34 FAX 6514834549 POOLSIDE 1�002 <br /> . ' \ � � <br /> � � v V <br /> \ <br /> DStC I�CC1V�' <br /> Total Fee: $ permit#• <br /> Entered By: .---- <br /> CITY OF OPGONO-BUILDING PERMIT APPLYCATION <br /> AU iniormation m�ust��e me print all lnjorfirwtion) r���will be started.�� <br /> �� _,.�_�_. <br /> ------ <br /> �Y��YIN`Y"�i"""'w��r--+•-�-�-r.....�. ' . ._ . <br /> .....w+w��rr�.w�.a...�r�.�y������' <br /> a�,u���_ . , �_.....__..._ <br /> ___________�_r________ <br /> � - <br /> TgE APPLICAN'1'IS: (cirC�e or�e) OWNER O CONTRACTOR . <br /> JOB STTE ADDRESS: c7���� q i •�� � ,•J �A��I ZIP: ��S <br /> W[Il t6is be s P de of H[omea,Remodelers Showcase Home or other Display Home? <br /> ❑yes No Ifyes,�i specia/event permit is required wlth Police Departmen!and Ctty Counci/approvaA <br /> 60 dcry.�s prior to the event. SHutl/e bus service wi(/be required ullless applicant demonstrates <br /> sugcient on-site par�ing is avallab/e. Non permilted events wil/nol be a/lowed. <br /> I_ .,.. d �1-��- i'�"�" r�-� PHONE: (home) � o ��7� ��7� <br /> NAME OF OWNER: Q�+r.�..�.r �W�� <br /> �r.,nvc AnDxEss: r� 1�S� A�a:�•c��� ��+crr�r: O�:��o �, zir: � <br /> coN�c�roR: s�c( 5 .a.-��� � pAor�:�c��1l�3�-�a a <br /> CONTACTPERS4N: 1. �r .i" MOBILE/PAGER: 4�c% 7S`3`O 3/ � <br /> MpII.ING ADDRESS: � ,,,�`� ;(..�CITY:L i��C°B�oc�l�': S_�L7 <br /> STATE LICENSL: #��- EXPIRATION DATE• <br /> ARCHITECr/ENGINET"•R: C-� v� � fi PHONE: ���t 3�5 a �'�� <br /> MAII.Il�iG ADDRESS: j�r a t� r�. �tS h;�r_ „��� STRATtO : #..-7IP: �I <br /> NAME: _ <br /> TYPE OF WORK: Nevv Home Addition Accessory SLvcture � <br /> Mowe Home RemodellAlteration(ie:Siding,Windows) <br /> ���r ea�th movement may require MCWD review and peXlnits! <br /> PROPOSED WORK(dercribe in detain: �' ``f -� 'r — <br /> '�-�e�e � S' 'rl� �. <br /> l. L r4��. � e�r' <br /> �'i'OR1E5: SQ.FEET OF EACH FLOOR: <br /> �v,uF 3EI�ROOMS:_ GARAGE 5TALIS: ATTACI�D DETACHED_ <br /> ESTIMATED CONSTR�[TC i`ION VALi7A'�(3It texziu�„int;ia�3 j: � ��7 1 � <br /> ;;,_;-,�:_-r;,.w,��,,�;�i�y���,5�=:•e!s::���e:-r�:JE'�.Y34�.1 5.1:}CIli7!YD��ae lhaC U�e information above is comPlete and accurate; <br /> �z��,,,�,���;;,w��;e�;c.;�,i,��i�,aiucc w�ii��u�urc�anauces ar�d c�des of tlte City and with the 5tate Building <br /> � �t ».t� w v�iL S SF �: .,.. : �«� <br /> GOd6;tl�at i���eiarstae�d tYei-. is.^.�iE::�ttr:...E,.,.:..f Ev:tt'n e=n�,..t•.., rf�^%eEtt��e�L���._se.....,;uet. s�_�h,. .^.�tkr..+r.�;:c ... <br /> in see;vr�nce wiLli lhe appr�vved plan. <br /> �,PP�,ICAN'T'S SIGNA']�URE D'�TE' � // a � <br /> 31 <br /> I <br />