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r� <br /> • �, �3:����l� <br /> .� , ` <br /> � '1'�tal N'ee• � ��� � �� 1)atc Kcccived: �'���� <br /> �. <br /> ' �;�'v Fntcrcd By: '� Pcrmit#: � �_ <br /> � ,<, <br /> �., _ <br /> Cl?Y 4F ORONO - SUlLD1NG YH;KMIT APPL1CATiON <br /> All information must be submitted in 1'ull beforc ��lan rcview will be st�rte�l. <br /> ('ple�.�c print al�inf'ormnli�n) <br /> Ti�iF APPI,�C'ANT IS: (circ%i�ne) UWNE.�.t(_)It [:()I�TRACT012 <br /> JOB S1TE ADDRESS; ��0��4 s t , .�1�c/� Z1-I':�5� <br /> Will this bC� atrslde of Anmec, Rem�delers Showcd�e Hume or othcr Tlicrlay [lomc? <br /> � YCS O l��,ye,s, u.���eciul erer�l ptrrni!is rt�quircd tivi�h Pullee�l�pa�•tme►a[und C'ily C'uurlri!a��prova! <br /> GD dm�s prior ro Ihe enenl ,Slai.�[Ilhr!»,��.rr:rV(C�N+III I��!"i(/l�il'C'•i�U11IP.,s,c npplrcu��l clemurrslrc�t�s <br /> .ct�icic»1 nn-si�r pc�rk.in�;is��avai./uh/r. IVbrf-�)C/7i)1t1L•tI CVL'n/S 11.�1I/1f0!hE���/!!,warr! <br /> NAMf,nf nWNT,R: �rr� �jr...5,�[� PT-inlvf.: (h�mc) `�S� - ''j�- 7 0/ g <br /> (wvrk) <br /> MA�I,IN(: At)nRFSS: 330 � c. �S �o �.1�c�CITY; !'J,ro,ti� Z1Y: �,5�9/ <br /> CONTRACTOR: O�nr �—t �r�uc�.,,...,.f-�• • PHUNF: ��D - �3 a—�l�� <br /> CONTACT PERSUN; � v L� l� MOB1L�/['AGEitc ��e �9 0 ��'y�'8 <br /> MA1L1NtT Al1UltN,SS: /a r� �a ^� �e �.�, C1TY: �� G�( �rr: SZ 303 <br /> �"CA'1'�;L1C�;N5�: # �a �� � CXPIRAT.1ON UA'CE: �0 4 <br /> ARC[I1TT:CT/f;NGiNi:�R: 1'I InNC: <br /> MAiLING ADDR�SS; C'ITY: GIY; <br /> NAMC: RT,Ci15TRATiON; �F <br /> TYPE UF WU}tk: N�w Mome /ldditi�n Ac�cessury titructure <br /> M�ve H�me Remodel/Alleratiurt(ic, Siding, Windows) �. <br /> PIt()t'l)tiN;C)WORk(dcscrihci�l detai�: 9 r�o l���G�c� ����c�o�.J S <br /> STORiCS: sc�,r��;�;`i'c�F Fa►c:i��r�04R: <br /> NU. UF B.E1).RUUMS:_„ CA:kAGF�TALLS: ATTACH.FI) � r)ETAC11L1)� <br /> �:5'I'IMA'1'�;ll C'ONSTRiTCTi3ON VA1.,lTATInN(excludiii�land): $ 0• �0 <br /> 1 hereby npply far� huil�lin��>crmit:e.nd i ackno�vledge lhat the informxlic�n�hi�vc is c��mplete and accurate; <br /> th�t lhc wurk will br. in c.un'furmance with thc nrdinnnees and cndes�f�ho City�nd wir.h chE titate�uilJing <br /> Code;thnt 1 undtsrsl�tnd lhir i�r'iul.ri���rmit and work is�10L IO Si3rt withoul�.(��rnii�;and that the wurk will be <br /> in accurdxncc wi�f� tLc e�pprovcd ��It�n. <br /> APFI.IC:ANT'S SiGNATURE; � ��%v `� DATE: c�o�I'U(� <br /> 3i <br /> Z�ti'd 9T9b6bZZS6+:o1 68T6 0�Z 0Z� N3W�(IOJdWI 3WOH �1�OJ,�w��� bO�Lti 90aZ-ZZ-83� <br />