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Total Fee: $ 5/-3 Date Received: <br /> ,Entered By: C Permit#: 5-7 <br /> CITY 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 O CONTRACTOR~ <br /> JOB SITE ADDRESS: I C Wes i 4 r ri U� ZIP: .tri'3 q I <br /> • NAME OF OWNER: W t 1 ! 4 Q11 CA(61'14PHONE: (home) <br /> (work) <br /> MAILING ADDRESS: CITY: ZIP: <br /> CONTRACTOR: S VJ c2 drgrh�S PHONE: 47f- / <br /> CONTACT PERSON: cce 73i-e MOBILE/PAGER: .C9 9- 4-ft Z <br /> MAILING ADDRESS: I DC. lc,. 51.--oac/4Aral CITY: Wa15,,,-iq ZIP: fr3 q/ <br /> STATE LICENSE: # 2 4 8 d <br /> ARCHITECT/ENGINEER: Y•1^a �- v._ PHONE: 470 ' q7YO <br /> MAILING ADDRESS: u CITY: ZIP: <br /> NAME: REGISTRATION# <br /> TYPE OF WORK: New X Addition Accessory Structure <br /> Move Remodel/Alteration Land Alteration <br /> PROPOSED WORK(describe in detail): rC e ) S 1 <br /> STORIES: SQ.FEET OF EACH FLOOR: Z 7,0 -3 I q ( 9 - <br /> NO. OF BEDROOMS: 4 GARAGE STALLS: ATT. 3 DET. <br /> ESTIMATED CONSTRUCTION VALUATION (excluding land): $ .5.So,J o 0 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: 1 h— UOQ. ( LL DATE: 7/2 3 /98 <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 />