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CITY OF cORONO - BUILDING PERMIT APPLICATION <br /> Total Fee: $ (o/,5 45 Date Received: <br /> Entered By: 631,o `/(3 <br /> 7 <br /> Date Approved: 7 Permit#: / Y O <br /> ALL INFORMATION MUST BE SUBMIIrmU IN FULL BEFORE PLAN REVIEW WILL BE STARTED <br /> (See Check-off List Enclosed) <br /> THE APPLICANT IS: (circle one) QWNER r CONTRACTOR <br /> JOB SITE ADDRESS: , 35V In. Ai... ( 1-Ub ZIP: , .S 3 <br /> V <br /> ,/��1 tt ,, (work) (`job. <br /> NAME OF OWNER: 1E. -0-05 bliP6oei PHONE: (home) /11/4/ <br /> MAILING ADDRESS: p 1 O, �t CITY:O#J6 L t- ZIP: <br /> CONTRACTOR: 07-2 Ai t3/2CS (V u 12 PHONE:fn/, -/ '':'v4i. r <br /> MAILING ADDRESS:f . 'off c;11'1 CITY:J,06tj l{ ZIP: S, 's <br /> TYPE OF WORK: New Addition Accessory Structure Move <br /> Demo Remodel/Alteration Renovate Land A eration <br /> PROPOSED WORK (describe in detail) : 7,74 /5-74t G 4,t/ /; ii4 -A4ce IN for-,4doy <br /> /)fAilit no Zo/ ,a,r dc.,dr.o. ,r ci✓,4win14 -a - ?/ <br /> D - , .5F <br /> STORIES: SQ. FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. <br /> ESTIMATED CONSTRUCTION VALUATION (excluding land) : $ /300. <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 permit and work is not to start without a permit; and <br /> that the work will be in accordance with the approved plan. <br /> APPLICANT'S SIGNATURE:' '`�' " DATE: <br />