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� CITYOF <br /> /O'RONO - BUILDING PERMIT APPLICATION <br /> Total Fee: $ 1 bob `► S Date Received: <br /> Date Approved: <br /> Entered By: q� <br /> permit#: 37q <br /> ALL INFORMATION MUST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED <br /> (See Check-off List Enclosed) <br /> -------------------------------------------------------------------------------- <br /> THE APPLICANT IS: (circle one) OWNER or CONTRACTOR C <br /> JOB SITE ADDRESS: �-qU W � Q.t C� ZIP: <br /> f _ (work) <br /> NAME OF OWNER: 9i,1 W � 1 PHONE: (home) 7 3 S 27 <br /> MAILING ADDRESS: J-�� tIJO�kQ �. CITY: �CU tib ZIP: SS3� <br /> CONTRACTOR: `J 1 Q 1�`(` �Vti S PHONE:- <br /> 'MAILING <br /> HONE:'MAILING ADDRESS: %U0� C��� at}Q , S, CITY: tau ( ZIP: <br /> TYPE OF WORK: New Addition Accessory Structure Move <br /> Demo RemoUe/Alteration Renovate Land Alteration <br /> PROPOSED WORK (describe in detail) : ,LAX Y �� 1\ A <br /> yyaS�- �� <br /> STORIES: SQ. FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. <br /> ESTIMATED CONSTRUCTION VALUATION (excluding land) : $ d <br /> I hereby apply 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 /> ordinances and codes of the City and with the State Building Code; that I <br /> understand this is not a ermit and work is not to start without a permit; and <br /> that the work will be in a cordance wit the approved plan. <br /> APPLICANT'S SIGNATURE: DATE: - �1 9. 1 <br />