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Fr-�=�rn : I:EF! Lil_IF'F' F'HO�dE �l�-�. : r,1� _+�� � '_''� -��F�. G=t� 1-���=� 1�-i:-1;Hf'1 F't-��
<br /> (:11Y �F UR9NG � 6124/.SU51U U�/��15�Ei '1S:�S � :U�/U� N[�•hK�
<br /> '�'atal F��: $ Y l�'�_/ AB�te Rcceived:�� �`7��
<br /> Er►tered $Y� ...._...: ,..__,�.�,�. Aer�nnkt�►: ,/,()��?(o ...�.
<br /> GITY Q� Q�Q�VCJ - BUI�,.DING PERMYT AI�YL�CA'��QN
<br /> A,11 �nfo��m�tjon mu.�t be su�tinlitcd in i��ll bek'ore plan revfew� will bc sta.rtec�.
<br /> (please�r�n��r611�'ormr�rtan)
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<br /> '�"Hk: APPI,ICANT 13: (circic ane) OWNE�t O �OhT7'1ZAC'X'C}R-`---
<br /> Jl?Ii �YTE ADDIt�SS: , �� � t �. ���o-�,,,,,r "L1Y: �
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<br /> 1'riAltii� OF �WNPR:-.�c� �-. �-.-w It ---- PHO�'F: (harne).
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<br /> M,A.�.YNG ADr1RFS5: �Z t 1 �a.��i,s�._..�� CYTY: . C�`�o ti sZ..�. � ZI�'; --
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<br /> CONTA�TP�RS�N:___�,.�y_�'.�.�� I1�IOBQ,E/Pr+,.C���t: - - -- �.
<br /> MAILIN�AY}I�R�SS: �'�a �,-E-�,#E..��,�.d GITY: rn ,w N�:��,�.w ZIP:� �S 2 5
<br /> STA.'!'� LI+CENSE: JI ���g . . . -
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<br /> ARC'Hi"�'E�'�`J�:NGIS�k,R: C,r�[.� �.JP �? PHON�: ���..-.��.��
<br /> MA�I.�INC A,.'DI)R�SS: _ CITY: ���'�-�� c , ZIP: �`
<br /> Nt�ME: � ___ _ REGISTR-A�TION# ! -J`�`` .� �
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<br /> 7'YPE �F W'ORK: New - -- _..,_ Additian Acc�s�ory S�ucturc
<br /> Move �� Remodel�Attc�ation �_ Lt�nd Alt�ratiort „ ,
<br /> PR�POSE'U WQRK (de,�rribe rn d'et�iF}' ��� r»��c� ,�"���?�t..��- ,,�[c'r���?.�l�
<br /> ��r���-�-�►-�-�-��.= �/y'� ��.....��r''��1 � a���')11 .,,,-� -- -- -- .,-�.._
<br /> ST(�RIES: r� SQ. FEFT�F$AC�FLObR: ._...�.._.._
<br /> NO. bF BE�11RC10ri�S: ___ _ ____ �ARAGE STALLS: AT`�'..,,,,� _ ��T.�
<br /> ��1Iri'YA'I�17 Ct�1V5T2�UC�'Yl7N VAx.UATICyN (exciuding li�ad�: $_ � J � ._ . ,�.
<br /> I hcr�by apply for a building prrmit and � acknowledge th�t the infor�r��t�u���l.�ove is camplc�e and
<br /> �cCurate; that the wr�rk will bc in canformB�nCe wlth the ordinances ancl co�l�s c�t`tlye C`ity ar�d with
<br /> 111a Statc k�uilcling ���dc; t��at 1 u�►�czstarid thip is r10i � �c=tmit and w�rk is n�t to F���+rt witlti�u� t�
<br /> germit; and tha[ the w�rk will bc it� ��cot'cfa e with the approv�d ptan.
<br /> r�►PPLIC:AN'1"5 5�.[iNA7'Uli�:: '! � ,t�.•� DA'1�+: �- �fj LL' `��
<br /> �a�� t� /.��
<br /> NO'�'E! �,���,� evenrs require sepa ate permtr ap,�rovnt hi� Pvlice Department and
<br /> G't�v G'aun�il f,U dQyS prior 1p th� ever�t, NPn p�rm�tted evertts wi11 rto! be ullawcd.
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