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CITY O� OR�70 - BIIIZ,DING PERMIT APPI,ICATION <br /> Total Fee: $ �� � ` '� Date Received: <br /> Date Approveci: <br /> E:ntered By: ��..1-�-�� Permit n: �' ���c%�; <br /> AT.T• INFORMATION MDST B$ SIIBMITTED IN FIILL BEFOR.E PI�N RE�7IEW WILL BE STARTED <br /> ( See Check-offlLiSt Enclosed) <br /> --------------------- <br /> ------'r------------ <br /> -------------------------- <br /> TgE APPLICANT IS: (circle one) WNER �Y CONTRACTOR <br /> JOB SITE ADDRRSS: 3�� J � ���" ZIP: <br /> (work) �� ��' � ��� <br /> / r�� <br /> �j ✓�n��� �C?�^ 'r`H�ii��: l'nome i L 7.r7 " 3 J <br /> NAME OF OWIYIIZ: 'l'�F� <br /> MATLING ADDRESS:11�/� ��/f y�/G'�'�� �I/L-� . CITY: �� ��i L-1`�T ZIP: S 5 ���� <br /> PHONE: <br /> CONTRACTOR: <br /> MAILING ADDRESS: CITY: ZIP: <br /> STATE LICENSE: ,� <br /> ARCHITECT/ENGINEER: PH��� <br /> MAIZING ADDR.ESS: CITY: ZIP: <br /> NAME: REGISTRATION � <br /> TYPE OF W New Addition Accessory Structure riove <br /> De Remodel/Alteration Renovate Land Alteration <br /> , t/ � <br /> -� l,� , <br /> PP.OPOSF..D WORR (describe in detail) : '� �C��UP�'`jf/�- � ������ / "������'�� <br /> , � � � y <br /> ;�y , �C� - f C'``��/ ' �C�.�:e- � l - — <br /> L <br /> STORIES:�,_ S4- F�T OF EACH FLOOR: <br /> NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. <br /> ESTIMATED CONSTI2IICTION VALIIATION (egcluding land) : $ <br /> I hereby apply for a building permit and I acknowledge that the information <br /> above is complete and accurat�; that the work will be in conformance wi�ha�he <br /> ordinances and codes of the C��ty and with the State Building Code, <br /> understand this is r_ot a permit and work is not to start without a permit; and <br /> that the work will be in accordance with the apprvved plan. <br /> APPI,ICANT'S SIGNATURE: DATE: <br /> ; <br /> - _ . . <br /> ``�l�� L�� ����- � . <br />