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� � t � � � �� � <br /> �, <br /> Total Fee: ' $ ` � 3 C �� �✓Date Received: '� C � <br /> Fntered B jZ�� - . �' ,�,�,�( �G'�'��' 1'ermit#: i��/ 3�`/c.,.z_. <br /> � y' � <br /> . . ` � CTI'Y OF 4RO�T� - SUII.DING PERMIT APPLICATTON <br /> � - . All i.nfot�mation.must be submitted in full before plan revxew will be started. � <br /> � � � �. '(please print all informaiion) � ' <br /> '�HE APPLYCANI' IS: (circle one) OWNER O CONTRACTOR <br /> ro� sY� �nn�ss: cc�ooar �Ilo �:. 55vq1 <br /> NAME OF OWNER: <br /> � PHUNE: .{tiome) 5�• �7/•8f 91' <br /> � . . � (work) 9 • 8 <br /> ' ' Zip':� <br /> M.4,II�1NG ADnRES5: '� Sl� CI'�'Y: <br /> � <br /> CONTRA.CTOR: PI�OIVE:.. -gjJ' - 'Jr'9C0� <br /> CONTACT PERSON: 0 M�$ILE(PAGER: • g � � <br /> 1V1AII„Il�iG ADDRESS: 555 i t� CTI'Y: ZIP: 553�13 <br /> �'''��'�; LICENSE: # ,�� <br /> _tCHTTECT/ENGINEER: , . . , , f . . - . . ' . pFIONE: . � .. ..� <br /> _�1.4,II.Il�iG ADDRESS: C�� Z�' <br /> N�,�: REGISTRA�'ION# <br /> TYPE Ok'�VORK: N�w Addxtion Accessary Smlcture <br /> Nl,ove Remodel/Alteration Land Altaration �I���`" �.0 <br /> PROPOSED'�'VORK(describe in detain: d � D <br /> O ' . <br /> ST4RIES: SQ. FEET 4F EACH�'LOOYt: <br /> NO. OF BED�tOOMS: � � GARAGE STA.LLS: ATT. DET. <br /> ESTAI�A1'ED CONSTR�CTCTION VALUATION (excluding lat�d): $ �7 S� • �� <br /> I hereby apply for a buildina pexmit and I ackiwwledge that the in�ormation above is complete and <br /> accurate;that the worlc wxll be in coz�formance with the ordinances ax�d codes of the City and with <br /> the State Bux�din� Code; that I understand this is not a permit and work is not to stazt without a <br /> pezmit; and that the work will be in acc r ce wirh the approved plan. <br /> APPLTCAIVT'S SIGNATUR�: `t DATE: I� '�g `�� <br /> N�TE! Parade of_ rrze events reQu e separate permit approvaF by Police Deparhnent and <br /> City Cauncii 60 days privr to the event. Non permitted euents will nv�be atlawed. <br /> 5 <br /> Z0IZ0 3Jdd O�Sfl�l dlOS3NNIW bb56-5�6-Z56 85�LZ Z00Z/6Z/0i <br />