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� - ,- CI� p�l��� BQILDING PffitMIT APPLICATION <br /> Total Fee: $ "� Date Received: <br /> � Date Approved: ���"��� � <br /> Entered By: <br /> Permit#: � <br /> AI�L INFORMATION MIIST BE SIIBMITTED IN FiJLL BEFORE PLAN REVIgW �i+iILL B$ STARTED <br /> (See Check-off List Enclosed)� � <br /> --------------------------------------------- � --------------------------- <br /> TH$ APPLICANT IS: (circle one) OWNER or CONTRACTOR <br /> �ly� -- Q (i 4�f�J ZIP: <br /> JOB SITE ADDRESS: �$ a r�v���► <br /> (work) 331-$7� � <br /> � oF owxEx: �uC t�H l�L lPS p$oxE: (home)331,�st3�' <br /> 1�lAILING ADDRESS: CITY: ZIP: <br /> CONTRACTOR: �/}�v G L�C k F�� uT �L DC� CO�{P• PHONE: S/7� � ��78 <br /> MAILING ADDRESS: 193� �v- Wfl Y2NTy 1�L vD CITY: /�Vi(/�o L.IU/(� ZIP: ��3�� <br /> TYP$ OF WORK: New� Addition Accessory Structure Move <br /> Demo Remo e /Alteration R�novate Land Alteration <br /> PROPOSED woRR (describe in detail) : ��W �"�.v 6 L� �H.�/�Y �O�N E " �w��1�/N� <br /> �^ �-C I C 'F W� ' <br /> STORIES: � SQ. FEET OF EACH FIAOR: o����' /�1 f���d "' �a?0 �l�v, /N 35�1 T. <br /> NO. OF BSDROOMS: 'Y GARAGE STAI.LS: ATT. � DET. <br /> $STIMATED CONSTRIICTION VALIIATION (ezclnding land) : $ /�� d��• <br /> I hereby apply for a building permit and I acknowledge that the information <br /> above is complete and accurate; that the work will be in conformance with the <br /> ordinances and codes of the City and with the State Building Code; that I <br /> understand this is not a permit and w$rk is not to� start without a permit; and <br /> that the work wil 1 be in accordance with the approved plan. <br /> APPLICANT'S SIGL�l1'OItS� ��°` DATS: �"2��l'a <br />