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�w <br /> CITY OF CRC270 - BJILDZ27G FER�ST A_PPLIG?TION <br /> � . �Z. <br /> � . �> --� � - <br /> Date Received : • <br /> otal Fee: $ <br /> rid�� E'-�D?"O�i c�C : <br /> n`orza R� PP,�;`� y ��3� <br /> :yL INFOR'�TION MQST BE SIIBMIT�ED IN FIILI, BEFORE PI�N RL�7IEW WILL BE START�'l.D <br /> (See Check-a=f List EncZosed) � <br /> ----------------- <br />�E p,FPI,�CANT IS: ( circle one) OSv'�IER or CO P.ACTOR <br /> �r � L <br />'1B SITE ADDR.$SS: ��� t��G7��L(�DO�� � �C� ZIP: 5=� � �� <br /> " (work) <br /> ���° � --.�;.�," � <br /> � � PHONE z (hcme)��� �� <br />=.ME OF OWN�R: c? C'%� L' � �C'i , <br />�ZING ADDRESS: �� � .J�� �'` t'GU�r <br /> CITY: l.��fJ'/� �J ZIP: .-�5 � �� <br /> .� <br /> � � 7 <br /> / � � PH rrE: ��� ����� - <br /> ��c�cR: 7�J ' <br /> ''� � �� CITY: "2�/ zIP: -��L� � <br /> ?'Z,ING ADDRESS: �7_Sc�� � <br /> ��� Lzc�s�: � I�DD-S�� <br /> PHONE- <br /> .�32 TE CT�E:IGINEER: <br /> CI�: ZIP: <br />'IZING A.DDR.ESS: <br /> REGISTR�TION :` <br /> ,��: <br /> � Addit�.on Accessory Structure riove <br />;�E OF WORK: Llew <br /> - De.no R�*nodel/Alteraticn Renovate .I�and Alteration <br /> ^ l <br /> / // �r' ��S <br />:OPOSED WORX (describe in detail) =r�!'�U � ,�"'PJ�s � Cl ��i'ltr.�r 4 -C, c-�--- <br /> �, � , <br /> �`,i►n• �� " ci� � <br />:ORIES: SQ. FEET OF EAC3 FI.00R: <br /> pg gEDROOMS: Gf�•RAGE STAZI.S: ATT. DE'=• <br />�- � � <br /> ;��'�� ,_ <br />-TIMP,TED CONSTRQCTION VALIIATSON (esciuding Z�d) = S � <br /> nereby zDT7I�j for a building per.nit and I ac?�ncw�edge that the infor::�at-on <br />�ove is compl.ete and accurate; that the wor�C wil � be in conforinance with the <br />:3inances and codes of the City and with the S�ate Building Cede ; �'�at T <br />:3erstand this is not a permit and wor:c is not tc start without a per�nit; and <br />•.at the work wiZl. be in accordance with the aporoved plan. <br /> �/3 '• <br /> o/'�C ti:� DATE: d � <br /> ,_T,ICs'�NT' S SIG:7ATIIRE: � - <br />