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<br /> CITY O� Q��s"�d� , ,,� ,✓J
<br /> BUILUING PE�?l;�-, �� ,,.�; ��=,��r_��, �.. r ���
<br /> fNSPECTOR �_�` ��,
<br /> OATc_� - --�-,c.�.�,j{�'^.Ir� T_--
<br /> CJ APPQr � ��
<br /> �t�� ��"` �����' Date Received: �- � ,���`�
<br /> ' c� t i �,t�tn �.D "
<br /> � �Fp i �nferr�d.$� r �; r � � � ,-L
<br /> Permit#: �.jl!j;�/
<br /> � , �� t - �
<br /> ��..� � S. L. ' � ` ... . . �LI�IT
<br /> ��f U �rr r .- � �'` �;.J �G ,� � � �-+��4��� - BUILDING PERMIT APPLICATION
<br /> �i t li ?c yC /,�o �,_�. � .f :;;i l � �i�: /i� 5n�tL'CIIEW.
<br /> �i t' i.�t��' �1 � v?e:.i �SP�vl�C.�� !1 .��IVIL.�3
<br /> ' All information must be submitted in full before plan review will be started.
<br /> (pleuse priizt all infoYniatioit)
<br /> -------------------------------------------------------------------------------------------------=-�--------------------
<br /> THE APPLICANT IS: (ci��cle one) .OWNE R CONTRACTOR
<br /> � /,� P
<br /> JOB SITE ADDRESS: � � � %'�� �.��/'/,�J,����r 1/� ZIP: .��� %��.,��j
<br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
<br /> ❑ yeS � NO Ifyes, a specia/eve��t pern�it is r'eqztired ii�ith Police Departrnent arid City Coamcil approval
<br /> 60 days prior to the event. Shuttle bz�s service�vi!(be reguired zu�less applicant dernonstrates
<br /> si��cient on-site parkir�g is available. Non permitted events�vill��ot be alloived.
<br /> I`lAll�IE�F�Wl`Z�I:: G�'Q'��'�'t'�� � U'Gpv'�'�� PI�ON�: (home)�-����f�`" ��l J�
<br /> �/C'ri�C�
<br /> /� -, �-,� (work) S(._ f�1,��; ,, �,���
<br /> MAILING ADDRESS: �"r �. ��JX .�J 7 CITY: ��5�G�N ZIP: .S�S'�sti �(��',Sf'
<br /> �OI�TF.AC"?'��:: 1��� PT�OI�IE:
<br /> CONTACT PERSON: �' '/P MOBILE/PAGER:
<br /> MAILING ADDRESS: CITY: ZIP:
<br /> STATE LICENSE: # EXPIRATION DATE:
<br /> ARCHITECT/ENGINEER J G� ��/���'��,��r S PHONE: 7�.j �" �f��—3 S'C' ,'
<br /> MAILING ADDRESS: CI�Y: �I�:
<br /> NAM�: REGISTRATION: #
<br /> TYPE OF WORK: New Home Addition � Accessory Structure
<br /> Move Home Remodel/Alteration (ie: Siding, Windows)
<br /> Any earth movement may require MCWD review and permits !
<br /> � PROPOSED WORK(descr�ihe in detai�: CG��/���ivrs ?�jil�i�j� /�''°�i�� �s'/'r,�,�i' '�'�+�� �" �z'%✓
<br /> � �/v �� �. C(d"'�d' �� � ��� C ' , �'✓P.tu C�2�,i✓`�' ��✓ �?.���i,r�! ��;y, ,
<br /> __�.� ^J h[�.=j.t!r:;;,,:'�
<br /> S�'ORiES: ,� � SQ.FEET OF EAC1�I FL0012: � ���� �;��d'/'' ��/I
<br /> 1�i0. OF BEDROOMS: ��'U GARAGE STALLS: ATTACHED y DET'ACI��J � ^ ;'��'•'
<br /> — ��� ��w�,�' -�,,�
<br /> � �"�'I��.✓ �/�"�J��:
<br /> ESTIMATED CONSTRUCTYON VALUATION (exclud'eng land): � ��j �0�,� .Z���f;`l
<br /> I��v+��� �FkCf.
<br /> I hereby apply for a buildin�permit and I acknowledge that the information above is complete and accurate; tQ ��,. �y,�„��rf�
<br /> that the work will be in conformance with the ordinances and codes of tf�e City and with the State Building ,a�, ,�, �,��t,�,,�
<br /> Code;that I understand this is not a permit and worlc is not to start�vithout a permit;and that the worl:�vill be l� �'�'�
<br /> �/t/�/�I SM,
<br /> in accordance with the approved plan.
<br /> �
<br /> APl'LICAI�1'I'°S SIGNAT�TI�E: �/ �" /��/ ����: � :T(,�c^1 Z(�C1 �
<br /> ` �
<br /> �1 �
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