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� r <br /> CITy pF ORONO - BIIIZDING PERMIT APPZIC�,TION <br /> ��f � � Date Received: <br /> Total Fee: $ � - <br /> Date Ac�roved: � <br /> Entered By: � Permit ff: �P ��° 7 � _ � . <br /> AT•T• IP7gOgMATION MIIST BS SIIBMITTED IN FDLL BEFORE PLAN REVIEW WII�L BE S�`gRTLD <br /> (See Chec3s-off List Enclosed) <br /> _ ----T IS:� (circie one) --OidNER o R.ACTO <br /> TgE APPLICAN � <br /> ` V ZIP: <br /> JOB SITE ADDRBSS: �- � <br /> � (work) <br /> � � ����-e c g PSONE: (hoine) <br /> NAME OF OWNER: \)/✓�r / . <br /> � CITY: ZIP: <br /> MATZ�ING ADDRESS: c�!"�S� i - <br /> CONTR�C'SOR: a <br /> p i r �-� ,e �`�a t-�,,c PHONE: <br /> .� n CITY: �o�i� c ZIP: ��v?� �� <br /> MA�Z�ING ADDRESS: 3�5� �����a� r' � �` <br /> ST�TE LICENSE: � G � 3a <br /> PHONE: <br /> p�RCHITECT/ENGINEER: <br /> ��q: ZIP: <br /> MAILSNG ADDRESS: <br /> REGISZ'R�+.TION 4 <br /> N�: <br /> Addition Accessory Structure Move � <br /> TYPE OF WORR: New Renovate Land Alteration <br /> D�o Remodel/Alteration <br /> .1� . .e d-� <br /> PROPOSED WORR (describe u le� <br /> STORZES: S4• FEST OF EBCH FLOOR: <br /> NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. _ <br /> gSTIMATED CONSTRIICTION VALIIATSON (eaclnding Ia.nd1 : $ �����_ <br /> 1 for a building permit and I acknowledge that the information <br /> I hereby app y that I <br /> above is complete and accurate; that the work will be in conformaCn�cde With t e <br /> ordinances and codes of the City and with the State Building e�it; and <br /> understand this is not a permit and work is not to start without a p <br /> that the werk wiZl be ia accordance with the approved plaa. _ . <br /> DATE: S- �- S�_ <br /> APPLICANT'S SIGNA7.'ORE: <br />