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� . f � If <br /> Total Fee: $ �(l`�f- �`1 Date Received: �"3� �� <br /> Entered By: `�jy��=���,�,�� ��� Permit#: AD 9/3Q <br /> CITY OF �R�N� - BUILDIN� PERMIT APPLICATION <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 OR CONTRACTOR <br /> JOB SITE ADDRESS: `?--�S �l,�'����I d�/✓ ZIP: �� 3'S � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? <br /> ❑ 1'es �P10 If yes, a special event permit is required with Police Department and City Council approval <br /> 60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates <br /> sufficient on-site parking is availab/e. Non permitted events will not be allowed. <br /> NAME OF OWNER: ��}VYI�S ,��'r'',� PHONE: (home)�S�Z-��S�J 7l0 <br /> v <br /> (work) <br /> MAILING ADDRESS: ���5 C���'�n�}�}�iv CITY: �'u�� ZIP:S�7s� <br /> CONTRACTOR: �l � PHONE: <br /> CONTACT PERSON: MOBILE/PAGER: <br /> MAILING ADDRESS: CITY: ZIP: <br /> STATE LICENSE: # EXPIRATION DATE: <br /> ARCHITECT/ENGINEER: PHONE: <br /> MAILING ADDRESS: CITY: ZIP: <br /> NAME: REGISTRATION: # <br /> TYPE OF WORK: New Addition Accessory Structure � SItfO <br /> Move Home Remodel/Alteration <br /> PROPOSED WORK(describe in detai�: �DDiNCn P1�1.�-�!/�r" �?�f�/�Of �S1-f 50 <br /> lax zv <br /> STORIES: SQ.FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED <br /> cv <br /> ESTIMATED CONSTRUCTION VALUATION(excluding land): $ )(�40 ' <br /> I hereby apply for a building perinit and I acknowledge that the information above is complete and accurate; <br /> that the work will be in conforinance with the ordinances and codes of the City and with the State Building <br /> Code;that I understand this is not a pennit and work is not to start without a pennit;and that the work will be <br /> in accordance with the approved plan. <br /> APPLICANT'S SIGNATU r <br /> DATE: � � 3�� �7 <br /> 31 <br />