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Total Fee: $ Date Received: <br /> Entered By: Permit#: <br /> l:1 l Y Vr GR�NO - �LTIL�'lI�I G ��Rl�l l AY�L1C�1�'IOIV <br /> All information must be submitted in full before plan review will be started. <br /> (please print all information) � <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> THE APPLICANT IS: (circle one) OWNER O CONTRACTOR <br /> JOB SITE ADDRESS: p� 8 0� J� C�(�j f O �O I n � J��l ZIP: �j � a q I <br /> Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home? <br /> ❑ YeS �O Ifyes, a specia!event permit is required with Police Department and City Council approval <br /> 60 days prior to the event. Shu[tle bus service will be reguired unless applicant demonstrates <br /> sufficient on-site parking is available. Non pef�nzitted events will not be allowed. <br /> NAME OF OWNER: �C �f �b(' � `7 PHONE: (home) �($�( 3 3�(' ��3�j <br /> (work) <br /> MAILING ADDRESS: CITY: ZIP: <br /> THD At-Home Services Inc. <br /> CONTRACTOR: Dba The Home Depot At-Home Services PH��' Q S��$4 S- L b�('� <br /> CONTACT PERSON: _ 3200 Cobb Galleria Suite #200 AGER: Jod� !D ���t i` J bflt � <br /> MAILING ADDRESS: _ Atlanta GA 30339 Z�' <br /> STATE LICENSE: #_ License#20268257 - 763-542-8826 DATE: <br /> ARCHITECT/ENGIN�ER: PHONE: <br /> MAILING ADDRESS: CITY: ZIP: <br /> NAME: 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(clescribe in detai�: � Lv(i� C��L�1 !�Q Q�C'C.G �?C � 1�S <br /> (�l ,C'k r s r 11 cr� 6P-� � r ,�Ly� <br /> STORIES: SQ.FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED <br /> ESTIMATED CONSTRUCTION VALUATION(excluding land): $ ��� �� � <br /> I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; <br /> that the work will be in conformance with the ordinances and codes of the City and with the State Building <br /> Code;that I understand this is not a permit and work is not to start without a permit;and that the work will be <br /> in accordance with the approved plan. <br /> APPLICANT'S SIGNATURE:�` �" DATE: � a L � a <br /> � — <br /> 31 <br />