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R .., <br /> y � � <br /> __ ���� <br /> ' �� . �-3 ` . Date Received:�/�� <br /> Total Fee: $ � -.. _._.: <br /> Ent�r�� By: _���� =�E j�C�`�"{` P�rn;it#: �s;/�1�/e' -� <br /> `�-�'"j�'�' `/ ���, �� � f�i .y��� <br /> GTI'Y OF l'��O O - B�D�NG P�RMIT APPLICAI'ION <br /> Ail informa#ion must be submitted in full before plan review will be started. <br /> {please prir_t�lT inforr��an) � <br /> -�------r----------� --' <br /> THE APPLICANT IS: (circle one) dV�NER OR CtJNTRACT4R <br /> ��� s�� �vD�ss: ,� ���� ��l a�r ���k R� .�._zr�:, �`���y � <br /> NA.h�OF OWNER: �l�1�ei'l ��'N�'.-� PHONE: {home} 5� - �' f��L <br /> (work),�.5•3,- a `�'- ��az� <br /> 1VIAII.ING ADDRE.SS: -� v�"� W�u�CITY: ��i I Vl� ZIP':,�...,�.,�,...`�..� <br /> C4`'TRACT�R: L�t-�'Z�!v� r,�,11�f�',�,����''_ PHONE:.�� Z- ��e/- .3`!� 7 <br /> CUti'TACT PERSON: nr+�1 L�i2 K�v� MOBIIrElPAGER: :ff� � <br /> M.A I L I�i I G A D D I��E•S S: �-r i U�1.5 ��-i c�� j���eK,' I�I CITY�,�.1�s.�.�Si o�,,,,,,�IP:_���� / <br /> STA7�'E LICENSE: # � 3 �,/ <br /> � <br /> �Rcc�rrrrECTtE�vGIl+�EER: Pgart�: <br /> M�L�tG ADD1iT.SS• CI'TY: ?IP:_____�,_„ <br /> N 4.11E: REGISTR ATI4N# <br /> �'yPE C)F `VC)RK: New Ad�dition Accessory Structure <br /> Move RemodeilAiteratian�i Land Alteration <br /> PROPUSED`i�OItK(describe in detai�: � i�� � � �� <br /> , <br /> �,�_�_.._ �� +'' `�,. . �'',�,� <br /> p�� p�t c�.�� c:; w� [�,i�-� �'-�- i c( � Lv�t. l . A� . <br /> s�eo�s: � sQ.FEET OF EACH F L U O R: � �c� — <br /> �'v0. OF BEDROOi�iS: � . GARAGE STALLS: ATT. DET. <br /> ES'I'Y.i�ir�TED COYS1'RUCTIO�T VALUATION(excluding land}: $ ��f <�Z• �� <br /> T hereby apply for a building permit anti I a�lrnowl�dg�that the infc�rsnatinn above is complete and <br /> accurate; that the work will be in conformanc� with ihe ordinances and cod.es of the City and with <br /> the Stat� Building Code; that I understand this is nat a permit and work is not to start without a <br /> gerr�t; and that the wark wil�be in acc rdance with approved plan. <br /> APPLICANT'S SIGNATI3RE: ��� DA1'.E: .2-�� <br /> NOTE! Par f Homes events re�quire sepurate permit approval by�'olice Department and <br /> Ciiy Council 64 days prior tv the event. Nart permifted events wiU not be allnwed. <br />