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Total Fee: $ ��7., ,� Date Received: <br /> lEntered By: Permit#: '��3 412 <br /> C F ORONO - BUILDING PERMIT APPLICATION <br /> All information must be submitted in full before plan review will be started. <br /> (please print all information) <br /> THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR <br /> JOB SITE ADDRESS: 1..+`139 TOa kA y xkO Lwo b ZIP: SS3 6 LP <br /> NAME OF OWNER:.. LkatArj, (72ypN Nf,-66rj PHONE: (home) LE�S) b <br /> (work) <br /> MAILING ADDRESS: Za13W -�,,r ny�b� VA�6 CITY: mvp js ZIP: sS36y <br /> CONTRACTOR: -fib Q,�AwT S Cz o"cmw�o PHONE: �41 a, -S'1 i <br /> CONTACT PERSON: Z)6,,,, Ciao t-64 MOBILE/PAGER:e4So_voo a3 <br /> MAILING ADDRESS: t t a5 cvA J2.►� °► CITY:_,�,I o0,A ZIP: <_(�3 6y <br /> STATE LICENSE: # 36aa. <br /> ARCHITECT/ENGINEER: -'—"--' PHONE: --� <br /> MAILING ADDRESS: CITY.. — ZIP:—� <br /> NAME: - REGISTRATION# -� <br /> TYPE OF WORK: New Addition Accessory Structure <br /> Move Remodel/Alteration Land Alteration <br /> PROPOSED WORK(describe in detail): 1j*Z6,Roo� Homb (Im%-ou lam£ <br /> STORIES: SQ.FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. <br /> ESTIMATED CONSTRUCTION VALUATION(excluding land): $ 0.�— <br /> I hereby apply for a building permit 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 State Building Code; that I understand this is not a permit and work is not to start without a <br /> permit; and that the work will be in accordance with the approved plan. <br /> APPLICANT'S SIGNATURE: �c r.�. .�n DATE: <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 />