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All information must be submitted in full before plan review w�ill be started. <br /> (please print all information) <br /> ' ..�=:- ------------------------------------------------ <br /> ------------------------------- ____ <br /> , THE A.PPLICAI�'T IS: (circle one) O�VNE OR CONTR.ACTOR <br /> JOB SITE ADDRESS: S"� � � � �-�,s r �-_- � ZIP: ��35 � <br /> 1�TA1�iE OF Oti��R: ��-� � �� (�S PIiONE: (home) ��S 3 ��S 7 <br /> (work) ��%-- ���4 7 <br /> i�iAII,ING�,DDP.ESS: ��� � � �; t'�.,� �� Z CITY: ` �,1 e ZIP: -� � <br /> c•,�- <br /> CONTRACTOR: r' ss��- .-L ,< c�v':-�� „ - PHONE: <br /> CONTACTPERSON:�� n rvL� SSe?�C,�.- NiOBILE/PAGF�R: — <br /> MALLI\'G ADDRE,SS: ��1� 2� s�� �1�w+� �. CITY:��t�1�,x�- ZIP: <br /> STATE LICEl�'SE: # <br /> ARCHITECT/EI\'GIl�'EER: PHO�'E: <br /> �7AIL�TG ADDRESS: CITY: ZIP: _ <br /> vAME: REGISTRATION# <br /> TYPE OF `VORK: New Addition Accessory Structure <br /> Move Remodel/Alteration Land Alteration�_ <br /> PROPOSED`�ORK(describe in detai���1r.�- ' �-'� ' <br /> STORIES: SQ. FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. <br /> ESTIi�tA.TED CONSTRUCTION VALUATION (excluding land): $ � <br /> I hereby apply for a buildina pernut and I acknowledge that the information above is complete and <br /> accurate; that the work will be in conformance wich the ordinances and codes of the City and with <br /> the State Build:�� Code; that I understand this is not a permit and work is not to starc without a <br /> permit; and that the work will be in ac rdanc with the approved plan. <br /> - - ----- ,._�_, . ....�.�.r , n.��� L/i'�i�i <br />