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CITY OF URONO - BIIIZDING PERbLIT APPLIC�TION <br /> "' Date Received: J"�/��j,� <br /> To���l Fee: $ :{: >`�� �'r <br /> Da�e ��oroved: <br /> 1 - - <br /> �n�ered By: � ,�,?r,�'� .��-�� <br /> Per.nit r: <br /> �LL INFORMATION MIIST B$ SDBMIT'�ED IN FIILI. BEFORE PI,AN REVIEW WILL BS STAR�FD <br /> (See Check-off List Enclosed) <br /> -------------------------------- <br /> ---- T <br /> '�HE APPLICANT IS: (c�rcle cne) OWNEP or CONTRAC�OR <br /> JOB SITE ADDRBSS: ��� � � c� ZIP: �S ��=`f <br /> �/l•7u�r��1 , �i�s <br /> (work 1 �7Z -C i(;,� <br /> PHONE: (hc:�e) �/�/ - �` `''' I <br /> N� OF aWt7ER: ��'-1�� ' , �" � � ��''�-��-�� <br /> MAILING AnDxEss- I�FC� C�n.� Ir�� � ci�: -Z���+�d , /�I��' z�P: �5.� �-�`� <br /> CONTRACTOR: �'�`•'�-- f4 S �-�rv�- PfiONS: ''7�7/ - � C�F; � <br /> ?��'IZING ADDRESS: �.-� fl CITY: -�'�rr-�_ ZIP:-�;�-�-vL <br /> �� <br /> STATB ZI�ENSE: ,� <br /> �a� �-�-S.».,•, n L � �i��r--, PHONE- ���v - /� � � <br /> �Cai�r"'T'rrc '�-P�Fi�-: !--�cr� — <br /> � <br /> /�� �, CITY: �..1 f'��{r�.�•^� /'�iL�ZIP: �S 3 �� <br /> �SAIZING ADDP.$SS: � �) I G /�' L�� � � ' <br /> N�_ RBGISTRATION � <br /> X Accessor StrucLure Move <br /> `�'YPE OF WORR: New Addition Y <br /> Demo R��odel/Alteration Renov�te Land Alteration <br /> � !� .i 1-'` �u:.;� c I'✓ r'tiR c� �� a��- <br /> PP.OPOSED WORX (describe i.n detail) : /rvtY C��� G' � <br /> S ; s �- - L�%,�fh c��.c.-�< v,,,�_ � �'��o,�- a���c:. - <br /> � <br /> � "� Z °L �_ <br /> STORIES:�____�_� SQ. FEST OF EACH FLOOR: Z.(�� Fi- i. _ � "`_`���/ ��- <br /> :IO. OF BEDROOMSs C,�RAGS ST�S: ATT. DET. <br /> � <br /> �STIMA�ED CONSTRIICTION VALIIATION (eacluding Ia.nd) : $ �g��' <br /> � hereby apply for a building permit and I acknowledge that t'�e infor�atio: <br /> above is complete and accurate; that the work will be in conformance wi�a�h� <br /> ordinances and codes of the City and with the State Building Co ee�it; anc <br /> understand this is not a permit and work is not to start without a p <br /> �hat the work will be in accordance with the approved plan. � <br /> � �z�A_ ��.c.-c,,�.�. DATE: _�-� �� - �i,,S� <br /> AppI,ICANT'S SIGNA2'URE. <br />