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Q **v Qp ORONO ~ BCILDING P2RMIT APPLICATION <br />otal Fee; S <br />Date Received: <br />lJ cl ^ ^ <br />r^tered By:Penni^^-u • <br />LL TOTORMATION must BE SUBMITTED IN FULL BEFORE REVIEW WILL BE STARTEDJL INFORMATXUW nuo ChecJc-off List Enclosed) <br />as APPLICANT IS: (circle one) Ot'TNER or<^^TRACT_0^ <br />DB SITS ADDRESS: AqA I K\rrVV>—------------- ZIP. <br />(work) <br />IMB OP nwMER:PHONE: (home) Al 7_ -4€Hy <br />- <br />FILING ADDRESS: 4C)4) N\orVV-v 5!.V\tre- city :—0<~ <br />t>r <br />u; ^ <br />ZIP: <br />■^wtracto R: <br />. (^^g>0 $.Vti.\U.r C>c<c CITY: £>LCeV^>;or_____ ZIP:5_^^l1FILING ADDRESS <br />fAK-j r PHONE: \ 1 <br />PE OF WORK <br />Demo_ __ <br />New Addition <br />RemodeT/A1teration_ <br />Accessory Structure____ Move_ <br />Renovate_____ Land Alteration_ <br />3POSED WORK (describe in detail) ------- ~7 <br />IRIBS:SQ. FEET OF EACH FLOOR: <br />OF BEDROOMS:garage STALLS: ATT.DET. <br />ITBD COHSTROCnOH VALOATIOH (excluding land): $ ^ 7SP>?— <br />ereby apply for a building Pe^\be"to^rw^lT be'^ln <br />ye la complete a *='“”Hitv and with the State Building Code: that I <br />i“?anl this Is no^“a%fr:it\‘nd work is not to <br />t the work will be in accordance wxth the approved plan. <br />'FLICAHT'S SIGNATURE <br />DATE: