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, • • , w <br /> Total Fee: $ ,� �/�� . �-�� Date Received: f`l ( ` l,� �'i « <br /> � Entered By: 2�� Pernut#: _��� i � �/(.% � <br /> �Y�:� ���Z��'' �a�'--- <br /> CITY O�ORONO - BUILDING PERNIIT APPLICATION <br /> All information must be submitted in full before plan review will be started. <br /> (please print all information) <br /> THE APPLICANT IS: (circle one) OWNER OR ONTRACTOR <br /> JOB SITE ADDRESS: 2- 3�� �.�utdE ��Q,eZIP: ��,3 S� <br /> , . <br /> NAI�1E OF OWNER: �fi��E �t1�1 ST�D� PHONE: (home) g.52- y�s z�09 <br /> �j I (work) (o/Z - 3,�'Z- �18C>� <br /> MAILING ADDRESS: �.3.35 .�yiQa�d D,2 CITY: �ro�p ZIP: SS 3.5� <br /> CO\�TRACTOR: ��T�fv� !?� 5 --�1G PHONE: 9,�Z-�/�(P ��D,3 <br /> COr�TACT PERSON: JD� G.tLCr45 IOBILE/PAGER: 2 rZ Z r0 3 <br /> NLAII.PIG ADDRESS: i o�o fV • rown I� CITY: ZIP: 5�3,5'� <br /> ST�TE LICENSE: # Q <br /> ARCHITECT/ENGliYEER: PHO�TE: <br /> MAII.ING ADDRESS: CITY: ZIP: <br /> N�tiIE: REGISTRATION# <br /> TYPE OF `VORK: New Addition � Accessory Structure <br /> Move Remodel/Alteration Land Alteration <br /> PROPOSED WORK (describe in detain: Z S�R y 7�}�►/t-y /�ovin l�7`�`�d'i1 <br /> STORIES: SQ. FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. <br /> ESTL�IATED CONSTRUCTION VALUATI0�1 (exclud.ing land): $ ��� Da0 <br /> I hereby apply for a buildin� permit and I acknowledge that the information above is complete and <br /> accurate; that the work�vill be in conformance with the ordinances and codes of the City and with <br /> the State Buildin' Code; that I understand this is not a permit and work is not to start withbut a <br /> permit; and that the work wiII be in accordance w' the approved plan. <br /> APPLICA���''S SIGNATURE: DATE: ��V l� 3 <br /> NOTE! Parade of Homes events require separate permit approval by Police Department and <br /> Ciiy Council 60 days prior to the event. Non permitted events will not be allowed. <br /> 5 <br />