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. • �••• •• ••«• � •��u �••• �• �•••••� �VYYY'��I•�Y�Y I YY'� I .Y17L/YUD f�YLO <br /> * . 4� <br /> � Total Fee: $ y. �� Date�ccive�: 7—�U� <br /> Eater�d By: Permiz#c (�i'7 <br /> CI'�� �F OR0�1O - ���Il�t�P'3��1i�� �.YCA'�'IOI�T <br /> All information must be snbmitted in full be�ore plan review will be started. <br /> (please print all informarion) . <br /> ��_._..�_�_ _ .� _� -------� ----- -- --- <br /> ��PPLICAN'�IS; (circle one) OWNER OR CONTRACTOR <br /> ��B �I�7E A�DI)'dtIESS: r��3�1, Sln�.t�" w.x��4 �� ?�': 3"�3`�/ <br /> NANd[� OF O�VN�It: ��....�.� .,�y� �01TE: (hame) ��/-03� <br /> (work) <br /> 1l�A�LIle1G t�DatESS: 5'�.� � A�by��� L"7CTY: Z�: <br /> CON'f'�ACTOR: (L-�.�„ �,_� P�ONE: �L-�fY- 3�Q� <br /> CON'.�ACT Px.IZSOPt: `�n� _�,�<<<Z 1l�E;�H��+'lPA�iiD[�: <br /> M�iII.XNG A�D�SS: ��� :�• �_�� �.T!'Y: �',,,�.��,«c —G1Y: a � <br /> � <br /> STATE LYC�NS�: # � <br /> A�tC�cT/]ENGnvEER: �/.,�— p�oid'E: . <br /> lvl'Al9.�dldCs�ADDRESS: CTd''S'• �'� <br /> �r <br /> NA1V�: �gtEGgSTRATION# <br /> '1'�E ��dVpRK; l��w Additioa Accessory Saucmre <br /> Move Remodel/Alteration ,� Lan�d Altera.tiwn <br /> PROFOS]ED'WOIt�(describe in detai�: �.. 7 � !f.�L ,��1.,��n.�*' c�.�.✓�E�rs <br /> � �q���Ei,7•��. �►`n�.t, r <br /> 8� <br /> STOR]�S: �1_ � ��.�+:FT�FFACgF�.(ZOR: ,�//�- . <br /> NO. OF BEDROOMS: N� GARAG� STAI,LS: ATT. DET. <br /> L9'1'�1v�A'x'�LL CONSTItUCaH01�]VALUA7l'ION(�ctutlfug lancn: $ i z/���- '� _ <br /> I herebY app1Y�Qz a buildi�permit and I aclrnow'Ledge that the information abave is comple�e and <br /> aceurate; rhat the work will be i.a.conforniance with the ordfinances and codes of rhe Cicy and wirh <br /> the State Building Code; �hat I uucierstand this is not a pennit and work is not to stazt withwt a <br /> pernnic; and rhat the work will.be ia aceordancr. witb r.he approved plan. <br /> ��Yc��s s��N,��: ���: ��r/� <br /> ,N���r ,�events require separate permit dpprnval by Police De�arl�iient and <br /> � Cfty Councr.l 60 days,prior to the ever� 1Von petnutted events w�ll not be allowed. <br /> ti/E ' d L£6l ' �N 0060-ti68 (Zl9) NW S�3N91S30-� Wd9£� L OOOl '9 ' I �� <br />