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� "� CITY OF C1'�20IvOw - BUILDING PERM.IT A.PPLICATION <br /> Total Fee: $ ��/, �/t� Date Received: <br /> Date Approved: <br /> Entered By: ' �'� , permi t�: ,� ,.��� <br /> A7•T• INFORMATION MIIST BS SIIBMITT� IN FIIr1I, BEFORE PLAN REVIEW WII.L B$ STARTED <br /> (See Check-off List Enclosed) <br /> -------------------------------------------------------------------------------- <br /> TSE APPLICANT IS: (circle one) OWNER or CONTRACTOR <br /> Jos ss� �Dxsss: Z�1 t�� �,�� ���c�;� AP�v� zzP: �"�'� S� <br /> (work) 7�`/ -73�' � <br /> N� OF OWNER: pG/ly f�1l�A �i�� IUc���/]�E� PHONE: (hoine) ��' -UIU� <br /> MAILING ADDRESS: IZC?� Y+4-�.�. �C►4C�i �.il}�#1 .�}CITY: i�tNtiC=:Mt�1'd�� ZIP: ���?� <br /> CONTRACTOR: Ci'�btil�1 C I'��U�S /NC�-: PHONB: '�i�y��77 �� <br /> MAII�ING ADDRESS: /a�� ��� �tV��L D �'�� CITY: �-'►�kkC�t'"c-t ZIP: /L1ti <br /> STATS LICENSE: � �1G(i /�L+�v_`� <br /> ARCHITECT/ENGINEER: �G'N C - Dc��ln� ��,�-� i/�D PHorr�: <br /> � <br /> MAILING ADDRSSS: CITY: ZIP: <br /> rIAME: RBGISTRATIOA A <br /> TYPE OF WORR: New� Addition Accessory Structure Move <br /> Demo Remodel/Alteration Renovate Land Alteration <br /> PROPoSED woxx (aescribe in aetail) :�'��C�C 1'� �i������4 I�o�l- w �rH <br /> �TTn►-c ItEi� S�� 9 <br /> STORISS: SQ. FEBT OF EACH FLOOR: <br /> �70. OF B$DROOMS: GARAG$ STALI�S: ATT. DET. <br /> ESTIMATED CONSTRIICTION VALIIATION (eaclndi.ng land) : $ ��,� • � � <br /> Z hereby appl.y 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 /> �rdinances and codes of the City and with the State Building Code; that I <br /> �inderstand this is not a permit and work is not to start without a permit; and <br /> ;�at the work wiI 1 be in accordance with the approved plan. , <br /> �,PPLICANT'S SIGNATURE: DATE: (L `��� ��� <br />