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F’ab-X4-dl 09: IIP John Thomas Homos* Inc. eiZ 471 094S P.03 <br />7.WhhinSwoildqgdmofaupcntnirturiteniavilrafliiilta^MeAMidiaiiiif <j||0 <br />lilt ihd be left deao ud deir of tn dMi| «4th ny CKCiwiticMi filed with Mrth Itvil iMhh <br />the idjaceot muod fllevtilon («n^ when ludi cnmdoa is to be used u put of e new <br />bididifv end tudi new bdldmg U acxudhr Older constnieli^ <br />The undtrriamd ownar dud end heebby dote iadedniiy and hold haanltfs tte Chy of <br />OrooOi iti egerti^ tnployecs tod ewjdi* ftoa and aD ^i*^*»*, <br />ca peo ie%indudimaitotnayftattaftih>stftieCi^,itiagcnti^enqdoyteaandasdyaaiidi^ <br />out of or lewItiqB ftom tilt deoKddoD dasedbed benin as parfbfi^ by the property owna. <br />Ml enployeeik agesu, sdicenmeioif or assigDS. <br />fCHMir TYFE AND IZE CALCClAIIOIf <br />SSO.OO • Vrindpal Stnieoire <br />___ S30.00 - Aooeiioiy Stiuciurt <br />1. Subtotal of above pcmitiequeatcd S <br />2. State Sureharpa I <br />, • . ^ <br />J. TOTAL PERMIT lEE (add Kon 1-2 tbovt) t <br />toO <br />The uodanipied Imeby qqdiei to ftM City of Orooo ibr Uniaaea of a Demofidoa Ptnalt. agrees to <br />do all work in strict acemianea wifti dw ordiaaaces of Aa City and the f^uIadOBS of tte StaM of <br />MtooeiotA and certifies that aD statamenb pMda on this applieatioa are ooeapleta, tnia tad ooffcoL <br />APPUCANT S SIGNATC <br />OWNER'S SIGNATCREi____ <br />X. <br />f - <br />•--------s <br />Date: I <br />DMe: •'.//I * <br />APPROVED BY;Date: 2 o>