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, - , CITY OF pRONO - BQILDING PERMIT APPLICATION <br /> � Date Received: <br /> Total Fee: $ - <br /> Date A��rove�: � <br /> Entered By: PermitQ: _ � <br /> AT.T. IPTpORMP,TION MIIST BS SiTBMITTED Il`t FLnZ BEFORE PLAN REVIEW WIIS BS ST`BRTI�D <br /> (See Check-off List Enclosed) ____ <br /> ----------------------------------OS�INER a <br /> . ONTRACTOR.__..-� <br /> T� APPLICANT I5: (czrcle one) .�._... _` _...... <br /> � � ZIP: <br /> JOB SITE ADDRBSS: <br /> � (work) <br /> � / ` pgpNE: (home) <br /> g�.ME OF OWNP•R: L>� / / S/M �- . <br /> CITY: ZIP: <br /> MATZ�ING ADDRESS: <br /> � ��r�r-e, mc� 2 . PHONE: �' !I �` <br /> CONTRAC'SOR: <br /> �, n ci�: f��� ziP: �'.:310�/ <br /> 1KATI.ING ADDRESS: � � Ov� � <br /> sTATE LICENSE: � �-/y�� — <br /> � PHONE: <br /> ARCHITECT/ENGINEER% <br /> ��: ZIP: <br /> MATI�ING ADDRESS: <br /> REGISTRATION u <br /> NAME: <br /> Accessory Structure Move � <br /> Z•ypg pg WpgR; New Addition Land Alteration_,_ <br /> Demo Remodel/Alteration Renovate <br /> PROPOSF.D WORR (describe in detail) : <br /> STORIES: SQ. FEST OF EACH FLOOR: <br /> NO. OF BEDROOMS: <br /> G�gp,Gg gT�LI�S: ATT. DET. <br /> g,STI�� CONSTRIICTION VALIIATION (eaclnding land) : $ ���� �— <br /> I for a building permit and I acknowledge that the information <br /> I hereby app y that I <br /> above is ccmplete and accurate; that the work will be in conformaCn�cdewith t e <br /> ordinances and codes of the City and with the State Buildinq e�it; and <br /> understand this is not a permit and work is notr ov stpi�ithout a p <br /> that the work wiZ 1 be in accordance with the app . _ • <br /> �: � 2_ — 9� <br /> APPZ�ICANT'S SIGNATDRE: <br />