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CIT OFORONO - BUILDING PERMIT APPLICATION <br /> Fee• $ - '���• ..41 , 0� Date Received: q2...s-77JTotal <br /> ' Date Approved: <br /> �`J <br /> Entered By: �, � 5 ! (P �j <br /> Perrnit#: <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) OWNER or CONTRACTOR J <br /> JOB SITE ADDRESS: ) b LAeti PAce_. ZIP: • , v �/ <br /> (work) ?,VS- x 9 7 <br /> NAME OF OWNER: S (4 5a.v it&Lt ,e lilI` Ie PHONE: (home) L/ 2/- e?s$ <br /> MAILING ADDRESS: Sat/14e. CITY: SCMAQ ZIP: 3adi-Q c <br /> Zo Usew v1 ccp /u'1, PHONE: / 9[� 'S6.3 <br /> CONTRACTOR: /l ,�/�� � / � I <br /> MAILING ADDRESS: 3 96 /IW 7 CITY: FxCe(.Sivf ZIP: 5633 I <br /> STATE LICENSE: # <br /> ARCHITECT/ENGINEER: &A R. PHONE: <br /> MAILING ADDRESS: CITY: ZIP: <br /> NAME: REGISTRATION # <br /> TYPE OF WORK: New Addition Accessory Structure Move <br /> Demo Remodel/Alteration Renovate Land Alteration __- <br /> PROPOSED WORK (describe in detail) : S r(4A ("019,4 t 1,16Atewle i <br /> ac d1� #�� �,e,, 150 �� ;c- ar s 0 ) <br /> STORIES: SQ. FEET OF EACH FLOOR: / Z---06 */3/ 4t'Aba r` I/ <br /> NO. OF BEDROOMS: Z GARAGE STALLS: ATT. [ DET. <br /> 0th! <br /> ESTIMATED CONSTRUCTION VALUATION (excluding land) : $5-0(90` <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 i ;cco dance kith the approved plan. 25- <br /> 14, filf <br /> APPLICANT'S SIGNATURE: I , DATE: VIIIii?-3 <br /> 0 <br />