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k <br /> / �� <br /> Total Fee: $ ���f�=s� � ��� ��=�� <br /> Date Received: <br /> Entered By: k'!-� Permit#: %'j �? >>�3 `�`T_ <br /> �;�; ,;�;: <br /> , <br /> CITY OF C'SRONO -i BUII.,DING PERMIT APPLICATION <br /> All information must be submitted in full before plan review will be started. <br /> (please print all information) <br /> ------------------------------------------------ -- <br /> - ------ ----- --------------- -------------------------- <br /> THE APPLICANT IS: (circle one) �WNER�R CONTRACTOR <br /> JOB SITE ADDRESS: �� J+"�'� I �-�n �c'� ZIP: ���r�� 1 <br /> � � <br /> N�iE OF OWNER: �p`�, C��Z DLy�{� ��l�f�� PHO��tE: ome "��� �OCO �-�-..�- <br /> . I ( L '�, (�jrk) ��1 (0' �J l.o �-� <br /> MAILING ADDRESS: �-t D �7'11 I�1 ��-PJ CITY: IVrL�YI (� ZIP: � ' ��'l ( <br /> CO\"TRACTOR: V�'1 � PHO��: -f �� ' ��0� �/ <br /> COr�T'ACT PERSON: ` NIOBILE/PAGER: "" G <br /> NL4II.I�i 1G ADDRESS: �;�7 � G-�r,, CITY: ZIP: <br /> ST�,TE LICENSE: # <br /> ARCHITECT/ENGINEER: � , � PHONE�7(� � D (Ur�� <br /> NIAILI`i'G ADDRESS: j �- CITY: ZIP: � _ j � l <br /> NA_`IE: REGISTRAT� # <br /> TYPE OF WORK: New Addition Accessory Structure <br /> Move Remodel/Alteration � Land Alteration <br /> P OSED WO . ain: �S�( � N� ���a��� <br /> -t�� � '1 �,l `--;.� <br /> �; 1--.�-� - . <br /> STORIES: 2 SQ. FEET OF EACH FLOOR: % G U � �Gr L� <br /> NO. OF BEDROOMS: � � GARAGE STALLS: ATT. DET. <br /> � � <br /> ESTLI�IATED CONSTRUCTION VALUATION (excluding land): $ ����1� ����� . <br /> I hereby apply for a buildin�pernut and I acknowledge that the information above is complete and <br /> accurate; that the work will be in conformance with the ordinances and codes of the City and with <br /> the S�te Buildin� Code; that I understand this is not a permit and work is not to start without a <br /> permit; and that the work wi17 be in/j'�(''`c rdance with the approved plan. <br /> / 1 <br /> APPLICA1VT'S SIGNATURE: � L�� DATE: �/ �� Z�d � <br /> NOTE! Parade of Homes events require separate permit approval by Police Department and <br /> City Council 60 days prior to the event. Non permitted events will not be allowed. <br /> 5 <br />