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CITY OF CRCNO - BIIILDING PERMLIT APPLICATION <br />:)tal Fee: $ <br /> -77 <br /> 0 Date Received: 16 : /3 _ y <br /> Date Apuroved: <br /> Ztered Bv: � <br /> po,,.t; <br />:L INFORMATION MUST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED <br /> (See Check-off List Enclosed) <br /> ----------------- <br /> APPLICANT IS: (circle one) CMi'4ER or CONTRACTOR <br />)B SITE ADDRESS: / �D �o ZIP: <br /> 4-,A^11 j V � e) �� (work) 73-� � <br /> OF OWNER: l �� F'� i �lv c,, PHONE: (home) <br />;.ICING ADDRESS- a �CITY: © r-C /V-► ZIP: <br /> �3T_z2ACTOR- PHONE: It 7 3 -7 <br /> TING ADDRESS: y�-( 15 1st A6y: �D1"� zip: c5 c�3�fp <br />'ATE LICrENSE: L — <br /> i.. <br />;CHITECT/ENGINEER: PHONE: <br /> ILING ADDRESS: <br /> - CITY: ZIP: -----__ <br />.2,iE- _�-- " REGISTRATION ' <br />'PE OF WORK: NewAddition Accessory Structure clove <br /> Demo Remodel/Alteration Renovate Land Alteration <br /> of <br /> JPOSED WORK (describe in detail) : i6U I <br /> -RIES: SQ- FEE T OF EACH FLOOR: <br /> _ <br /> OF BEDROOMS: GARAGE STALLS: <br /> ^IY.ATED CONSTRUCTION VALIIATION (excluding land) : S f�lJ•�� <br /> izerebv apply for a building permit and I acknowledge that the information <br /> ,v? is complete and accurate; that the work wil ' be in conformance with the <br /> 'finances and codes of the City and with the State Building Code; that I <br /> erstand this is not a permit and work is not - smart without a permit; and <br /> w.t the work will be in accordance with the approved plan. <br /> t,ICANT'S SIGNATURE: DATE: <br /> K <br />