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� � CZTY OF CRC'•IO - BUII�DI�IG FER:�-IT APPLICATION <br /> Total Fe�: $ Bate Received: / / Q 7 CZ---- <br /> Date A��roved: <br /> ,n <br /> � <br /> =�tered By: � �' Permit r: ��� l � <br /> AT•T, INFOXPi�TION MIIST BE SIIBMITTED IN FIILL BEFORE PI�AN REVIEW WILL BE STARTED <br /> (See Check-aif List Encl.osed} <br /> --------------------- <br /> ------------------------------------- <br /> �E APPLICANT IS: (circle one ) Ojv� or CONTttACTOR <br /> JOB SITE A.DDRBSS- �-��U �;, l�-- �`� � ZIP: ���3=�c� <br /> (wark) ri <br /> `��/ / � ����n PHONE: (home) � 7� � 7�b7 <br /> �I�.ML OF OWNER: � / O/',/'J <br /> �.x�zzxc a.�Dx�ss: /�"��� (., f:�, � �t,� cz�r: � o��c. �r.��— zzP: �s���� <br /> PHONE: <br /> :.ONTRAC�'OR: <br /> u.AII,ING ADDR.ESS: CITY: ZIP: <br /> STATE LICE:`7SE: _ <br /> r�.c2CHITECT/ENGSNEER: PH��� <br /> �iAIZING ADDRESS: CITY: ZIP: <br /> ,���_ REGISTRATION - <br /> TYPE OF WORR: �7ew Additian Accessory Struc�ure riove <br /> Demo Re.*nodel/Alteration Renovate Land Alte�'atioII� <br /> P�OPOSED WORK (describe in detail) :��/����-� �'�� ✓� -�-°-� ���G — <br /> 2 � ' � ^ — . <br /> � ,/,� ` ' <br /> STORIES: SQ. FEET OF EACH FI�OaR: <br /> NO_ OF BEDROOMS: G�,FtAGE STALI,S: ATT. DET. <br /> ESTIMATED CONSTRIICTION VALUATZON (egcluding land) : $ <br /> I hereby apol.y for a buil.ding permit and I ackncwledge that the infor:nat'on <br /> anove is compl.ete and accurate; that the work wil � be in conformance with the <br /> �rdinances and codes of the City and with the S�ate Building Cede; that I <br /> ::nderstand tinis is not a permit and work is nct tc start without a permit; and <br /> �hat the work will be in accordance with the aporoved plan. � <br /> �:,�_. <br /> �' �� � � �'z..- <br /> APPLICANT'S SIG�7ATQRE: - "- - ' � DATE:_� <br /> ,t ��o <br /> n a � , 1�� G�� . . <br /> b �C ��� �t � 1� a�c� . - <br />