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TctAl r*«£ $ <br />ciff OP oioso - icnjono p®mit awtioiTioii <br />* <br />Dat« P€C«lredj <br />7I ' <br />Date Approved:■» <br />Entered Bys <br />Permit I j <br />ALL XlfFOKJIATI MUST BE SUBMimD IM FUlX BSPOME FLAM REVX£H WILL I* STABTID <br />(See Check-off List Enclosed) <br />TfflB APPLICANT ISs (circle one) CWNER or COMTBACTOR <br />JOB SITB APORBSSa / i j\ \ 1 / /IIP: <br />(work) 7a/ I// <br />■ANB or OHmi 4?^ « t /5 r V * ^ ^____________________ PHOBBifhoae) y 7 a. "VI 3 c <br />MAILING AOORBSS: /<j-‘ S' O'L'J. / V 4 u w > 7 a » I CITY i Oft <?*■«? XlPa 5 1 ^ C V* <br />COimiACTOF:a PHONEI <br />NAILING ADDRESS:W ▲ .A (I •SIP: <br />TTPH OF ffOAKs New Addition__ Accessory Stmetare _ *^ve_ <br />Dead_ _ Remodel/Alteration Rencvete_ _ _ Lend Alteration^ <br />PBOFOSBD HOBX (describe la oetelDs i <br />STORIBSs SO. FEET OF BACH FLOORS <br />■O. OF BEDROOMS:GARAGE STALLS: ATT.OET. <br />KTIMATED COMSTROCTIOM VALUATION (excluding land): % <br />I hereby apply for a building permit and I ac)cnowledge that the iniormatlon <br />above is complete and accurate; that the work will be in conformance with the <br />ordinances and codes of the City and with the State Building Code; that I <br />understand this is not a permit and work is not to start without a permit; and <br />that the work will be in accordance with the approved plan. <br />APPLICANT'S SIGNATURE I ^DATE <br />9