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• <br /> CITY OF ©RONO ,- BUILDING PERMIT APPLICATION <br /> Total Fee: $ l ,i') .,``< Date Received: */3k3 <br /> Date Approved: <br /> Entered By: _„("} Permit# L , _ <br /> ALL INFORMATION MUST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED <br /> (See Check-off List Enclosed) <br /> THE APPLICANT IS: (circle one) or CONTRACTOR <br /> JOB SITE ADDRESS: 33Z i . LAkL ST. ZIP: 5, [LD <br /> L01\I1e rr� m (work) 9.417--10(00 <br /> NAME OF OWNER: 1-1; m• ff.:AG-14 PcJ G44 PHONE: (home) 41 7S-ZS7-47 <br /> MAILING ADDRESS: 332 V--', 1-1:\ >t. CITY: t_oN(e, k=-E ZIP: 5535(. .; <br /> CONTRACTOR: (j\A)PJ EZ PHONE: <br /> MAILING ADDRESS: ,CITY: ZIP: <br /> STATE LICENSE: # <br /> ARCHITECT/ENGINEER: 3 Er) L.A TZS DM Or T'/ADC PHONE: i330 - d O-1 <br /> MAILING ADDRESS: '73O I OHM'S LANE, SvirL 4E( CITY:t,,VIVrAPDU S ZIP: k;S'E135 <br /> NAME: -3ED 1-.1;1?— 60 REGISTRATION # I S 841 <br /> TYPE OF WORK: New Addition X Accessory Structure Move <br /> Demo Remodel/Alteration Renovate Land Alteration <br /> PROPOSED WORK (describe in detail) : ADD GadezED sub -Y"rb E4iHa05 ,)gulc.D FoLL <br /> i .10' ' . , ori GtAi T i STD,.. • W ILR. b <br /> "ora-Wt oNr, REiclr IC t <br /> STORIES: � SQ. FEET OF EACH FLOOR: g-4110MAIN N ) t tot. OPPre, IZ.O OPFEZ.VATO?J LEAL <br /> NO. OF BEDROOMS: .44.1L).$w. GARAGE STALLS: ATT. C) DET. ( E 15TH 14 A1ZACpE <br /> EY.111 -7 <br /> ESTIMATED CONSTRUCTION VALUATION (excluding land) : $ 5 7�510 <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: 641,4 /2)&e, 4&e, 4 DATE: 3/4/9?) <br />