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. SE�-19-2001 14�06 MGCO HSP-3RD 612 321 5279 P.02i05 <br /> � <br /> Total Fee: $ �� ' � Dace Received: <br /> Encered By: PermiL#: �� i'- -jc-; C' 1 <br /> C," -���; ���� <br /> f�'�'�� <br /> CYTY' O� OR�O � BUILDfNG PERMIT APPLICATYON <br /> � <br /> • All information must be su6mitted in fla11 before plan review will be started. <br /> (please print all information) <br /> TI� APPLICANT YS: (circle one) OWNER OR ONTRACTOR <br /> aoB srrE A.nnx�ss: . l �°�o Sh�,��, v� �� zrP: 5s 3°� ) <br /> � <br /> xa� oF o�: � b���" I��k Pxor�: �o�� asa•��s�o�6s <br /> (work) <br /> M�LL�TG aDDRESS: rrY: p�ay...o Z�: �4-1 <br /> 1 �So o•ro�2.n4 �m � S5 3�� <br /> COl\11�ClC1ORi 'w��� /YhC7�� \ iAO�� Vl �� ✓ZI � ✓�✓� <br /> CONTACT PERSON: �L.s•� rt,l,oe,��.�- MOBA.EIPAGER: Ccl L-ci�o-a4,09 <br /> MpiII.Il�1G ADDRESS: '�o o c..�s�,�lA„ � CrrY: 111p 15 ZIP: Ss o � <br /> STATE LICENSE: � �G �� �9 85Go <br /> �C G I 2 � 3 21 � S�'19 <br /> ARCHITECT/ENGIlVE,ER; P�ONE: <br /> M�1II,Il�IG ADDRESS: C1T'Y: Z]P: <br /> NANIE: R�GYSTRATION fl <br /> TYPE OF WORS: New� Addicion Accessory Structure <br /> Move RcmodeUAt�eration_� Land Alteratian <br /> PROPOSED WORK(describe in detai�:��'Z-'�� �22��-(La'6� Q�SI D�3112St- f�'''� <br /> STORIES: SQ. F�ET OF)'sAC�Y�'1�OOR: <br /> NO. UF�BEDROOMS: GARAGE STALLS: ATT. DET. <br /> ES1'TMATED CONSTRUCTION VALUAT'ION (excluding land): $ g) $S r <br /> I hereby apply for a buildin�permit and.I acla�owledge that the informa�ion above is comple�e and <br /> acrurare; rba,t the work wiU be in coafornsanc� wirh the ordinances and codes of che Ciry and wirli <br /> the S�ate Building Code; that Y uuderstand this is not a permi� arld work is not to star[ wi[houc a <br /> pernnit; afld chat the work will be in ecordat►ce with che approved plan. <br /> APPLICANT'S SIGNATCJ1tE: DATE: � �� ��I <br /> NDTE! Par�e o�onees events�egr�ire separate permit approval by Police Depam�aent and <br /> City G'ounci160 days prior to �he event. Non pern�itted events will not be allowed. <br />