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r <br />CITY OF CRCKO <br />r'ee: $ — <br />BDILDING PERMIT APPLICATICM <br />Date P«»«~^ive<3t ^ <br />•y <br />red By: <br />Date Approved <br />Pen.it I: <br />INTORMATIOH HtTST BB SUBMirTBI. IK PnU. PL^N RJr.’IEM WILE BB STARTED <br />(Sec Check-off List t-nclosed) _____ <br />APPLICA2JT IS: (circle cne) c <br />yin J /O >fo fL ^SITS ADDRESS:__3_6j£i <br />r CCHTRACTOR <br />DIP: ___ <br />I? <br />. C? OKIJER:__; <br />lid ^LDDR-KSS • <br />(work ) <br />pnOJIE: (hcne) <br />DIP: <br />7-prv'. >/ /rl'^\CrJ?OR <br />ADDP^SS: i - // > ,/ltL.:nG <br />s LICENSE: # <br />phone : (Tt/ ' V ^ ^ 9 QQ <br />Cim IIP: 3^\y— <br />'TECT/EIiGINEER: <br />:iJG ADDPwESS:___ <br />PEOirE: <br />C^T? 2 IIP: <br />registration # <br />, „ Ap»d'—-on Accessory Structure------- Kove^ <br />Rl“5a5T/Alta=«I;n^ Renovate- - - Land Alteratacn_ <br />y BEDROOMS:garage stalls : ATT.DET. <br />7*TED CONSTRDCTION valuation (excluding land): 5 -------------------- <br />-eby apply for a building conformance with the <br />e is complete and accurate; that the wo the State Building Code; that I <br />:ances and codes of the City and without a permit; and <br />IANT * S SIGNATURE <br />DATE: