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CITY OF �RC�Nf:,,,-. BQII.DING PERl�iIT APPI.IC�TION <br />�p '' / S� � Date Received: <br /> g' Total Fee: S � � - <br />� Date A�nroved: ' <br /> i (i <br />� ' ,�L-�1-�� � <br /> Entered Bv: Pe�nit� � � �' r - _= . <br />� AT•T• I27gOgriATION MIIST BS SUBMITTED Ir7 FULL BEFORE PI,AN RE�7SEW WZI�I, BE Sg�T� <br /> (See Check-aff List Enclosed) <br /> --------�------------- <br /> ---------------- <br /> ------- ;... <br /> ------------------ -- \ <br /> � pyppl,ICANT I5: (circle one) � O��E� or ,CflNT.QACTOR <br /> i <br /> �-- ---____ _; - • <br /> ) � � / <br /> -- � - - -- <br /> ZSP: � <br /> JOB SITE ADDRBSS: " r-c/�r� � � C t` �� ' <br /> (work) <br /> ) � h � �� . � c �r � h /, �r7 <br /> PHONE: (home) � �,1 - i �� '� �/_ <br /> NAME OF OWNER: �y�� �� �,,-� • . <br /> ,.- . -- � CSTY: �-�t-�t=-�� ZIP: � <br /> ����:>'�= � <br /> MAILING ADDRESS: Y,�! � rc' !<c s, ���� �� ti <br /> �' �.� . - � <br /> PHONE: <br /> CONTRACTOR: - <br /> ��: ZIP: <br /> MAT_T ING ADDRESS: <br /> STATE LIC._.�NSE: z <br /> PHONE= <br /> ARCHI TE CT/ENGINEF�t: <br /> CITY: ZIP: <br /> MATI,ING ADDR.ESS: <br /> R.EGISTRATSON � <br /> NAME: <br /> Accessory Stru��sre Move <br /> TYPE OP WORR- New Addition Land Alteration <br /> Demo <br /> Re.*nodel/Alteration Renovate�_ <br /> ,- yv ;�' i r-1 ��c � T r c �� 'r=� l�;" '�'3 � <br /> PROPOS� WORK (describe in detail) = �"�'= � � r <br /> ✓ n, 7 �:, :� ?(;r_ , <br /> STORIES: .� SQ. FEET OF E�� ��R= <br /> NO_ OF BF,DROOMS.�_ �A� ST�I`I'S: ATT. � DET. <br /> ; r <br /> EST=MATE� CDNSTRIICTSON VALIIATSON �e��lu�g landl $ ^ ` the information <br /> I hereby apply for a building permit and I acknowledge that <br /> - that the work will be in confo� Code;aithathe <br /> above is compl.ete and accurate, and with the State Buildinq e�it; and <br /> ordinances and codes of the City <br /> understand this is not a permit and work is not to start without a p <br /> t that the wor3c will be ia accordance with the approved pl.an. • ' <br /> � _ ✓; ' DATEs � /��' ��� <br /> �!� �� -��� � <br /> APPLIC�NT'S SIGPT�TQRE= <br />