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� , ___---�.. <br /> T--" � , <br /> ' Total Fee: $ �;'_ ��U � D�te Received: �—,�D� <br /> , Entered By: �� _ ,. s,��� Pernut#: _ : - <br /> �_r�6�� �.' -li � <br /> CITY OF�ORONO G PERMIT APPLICATION <br /> All information must be submitted in full before plan review will be started. <br /> _ � (please print all information) � <br /> THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR <br /> JOB SITE ADDRESS: '/i-lr���v ��« 12�.� ZIP:. SS 3� 1 <br /> NAME OF OWNER: ; � ( .�,�� n S PHONE: (home) �S-Z <br /> �.73—7�s L <br /> (work) <br /> MAILING ADDRESS: G{,,,�� CITY: �,� ZIp: <br /> CONTRACTOR: PHONE: � <br /> CONTACT PERSON: MOBILE/PAGER: <br /> MAILING ADDRESS: . . CITY: Zip; <br /> STATE LICENSE: # <br /> ARCHIT'ECTlENGINEER: PHOi�TE: <br /> MAII,ING ADDRESS: CITY: ZIP: <br /> N�ME: REGISTRATION# <br /> TYPE OF WORK: New Addition Accessory Structure <br /> Move Remodel/Alteration Land Alteration ;/ <br /> PROPOSED WORK(describe in detai�: �� ;��,, �c�� -J�- v <br /> -,--. . . _ <br /> ��� �l i� � <br /> STORIES: SQ. FEET OF EACH FLOOR: <br /> NO. OF BEDROOVIS: GARAGE STALLS: ATT. DET. <br /> ESTIMATED CONSTRUCTION VALUATION (excluding land): $ <br /> I hereby apply for a building permit and I acknowledge that the information above is complete and <br /> accurate; that the work will be in conformance with the ordinances and codes of the City and with <br /> the State Building Code; that I understand this is not a permit and work is not to start without a <br /> pemut; and that the work will be in accorda e with e approved plan. <br /> � � <br /> APPLICANT'S SIGNATLTRE: DATE; � �/�`/o Z <br /> � <br /> NOTE! Parade of Homes events require separate permit approval by Police Department and <br /> City Council 60 days prior to the event. Non permitted events will not be allowed. <br /> 5 <br />