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CITY OF JR(Xj - BUILDING PERMIT APPLICATION <br /> Total Fee: $ SCi 7 5 Date Received: <br /> Date Approved: <br /> Entered By: <br /> Permit#:�TA(74(0 <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 orCONTRACTOR <br /> JOB SITE ADDRESS: Pill . .�'h4 ,/e/Q It/, ZIP: S33S'd <br /> (work) <br /> NAME OF OWNER: a�'�/Y �"/�/U �r /�'��/V 7 l PHONE: (home) <br /> MAILING ADDRESS: f'®, /?"A CITY:,,,IGA g .0 f J <br /> c, M1 ZIP: <br /> CONTRACTOR: Sof/T/l PHONE: <br /> MAILING ADDRESS: CITY: ZIP: <br /> STATE LICENSE: # <br /> ARCHITECT/ENGINEER: /► //Jf t.1 CIC PHONE: - <br /> MAILING ADDRESS: 70.1" CITY: yZ• ZIP:- <br /> NAME:- <br /> IP:NAME: 4L'•/ 5_fQ REGISTRATION # <br /> TYPE OF WORK: New Addition Accessory Structure Move <br /> Demo Remodel/Alterations Renovate Land Alteration <br /> PROPOSED WORK (describe in detail) :_ - <br /> STORIES: SQ. FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS: `� GARAGE STARS: ATT. DET. Z <br /> ESTIMATED CONSTRUCTION VALUATION (excluding land) : $ 7 �� <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 /> �3 <br /> APPLICANT'S SIGNATURE: DATE: <br />