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,09/16{2004 10:07 7635517980 1,rf/ o'b� FIRST CHOICE EXTERIO PAGE 01 <br /> Sopi16-2004 08469m' From-CITY OF0l16 +9522494618`: T' ::P'.001/OQ� •. FrO 6 <br /> Total Fee: $ . . � '7,S,_�„_ Date RacBiv�d: . <br /> Entered By: , perditit#; a 9 . •:`•" . • :' �, <br /> PERMIT APPLICATION <br /> CITY OP ORON'O -SCUM <br /> •.ISI.. <br /> submitted in 11 before Plan reVie�v will be started. . . <br /> st be s � <br /> All inform <br /> atlo <br /> u �. <br /> (pleate:print cit �or►n ) • <br /> rrr►►�..�r�r.�w..."'w--^moi- .. <br /> OR CONTRACTO <br /> T APPLICANT IS: (circle orale). dWNE <br /> ,TOB SITEA;pDRESS: <br /> ZIP: <br /> nkA f Hi�mes <br /> de <br /> Remode166 Shi 'age iftnte�ar otherDisplay 40me? <br /> Will this be a P. <br /> El Yes ❑ No• �f yes, a speeiid evert. rr iC is required whiz Police Departm8rtt ct►r qty <br /> Council approval 60 s,ps iaf-to the event.:Non,permitted events w(1 not. <br /> bd allowed. <br /> NAME OF OWNER P�iCr : (dome) . . . <br /> MAILING ADDgESS: C, CITY: _ Gl�6L�., <br /> PHONE: <br /> CONTRACTOR <br /> k <br /> CONTACT PTRBOl�: M-OBILE/PAOER: <br /> G ADDS CITY' ZIP: <br /> MAILIN ' <br /> STATE LICENSE: #' <br /> GII�E <br /> E : <br /> PRONE::. <br /> AIYCHI <br /> TECT/EN .. <br /> MAILING ADDM9� 1. CITY: P. <br /> NAME: <br /> REGI TU, <br /> # <br /> TYPE OF WORX4 NeW.. ktegsory Strutt <br /> Addition Move ; <br /> Reniodel/Alteratioa Land Aiteral~lom <br /> PROPOSED WORK(describe in detafl)i <br /> S'I`OWES: _.._ SQ.FEV1'.OF TAC : I'LC10R: <br /> OF BEDIt0011!Y3s. GAIU— 19 S. : ATT'. ::. DET, •i <br /> ESTIMATED C0N9TRuCTION VALATi j '(excluding laud): S <br /> I hereby apply for a building1pexmit acid x acknovwledge at'the iz;fortna Wn,sbove is Lornplete end accurate;: t the,: <br /> work will be in conform=6 with the ordhaames and- 'de's of tho'City and with the State Building C66s;that.l <br /> understand tt:is is not a pennh and world is not t8 Maxi W M a permit,and that the work will be in secorda r ae with ' <br /> the approved plen. <br /> A►PPLICANT'S SIGNATURE; DATE: '—! <br />