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2001-P03823 - addn/remodel/repair
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2650 Countryside Drive West - 04-117-23-12-0014
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2001-P03823 - addn/remodel/repair
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Last modified
8/22/2023 5:07:08 PM
Creation date
5/2/2016 3:48:37 PM
Metadata
Fields
Template:
x Address Old
House Number
2650
Street Name
Countryside
Street Type
Drive
Street Direction
West
Address
2650 Countryside Dr W
Document Type
Permits/Inspections
PIN
0411723120014
Supplemental fields
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Updated
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Tc�tal Fee: $ �-� ��C�. �� Date Received: ��"� j � �'� <br /> Entered By: �c'� Permit�: C�/"; ���"� =; <br /> � . i��efti"�)� =` .-; -�; <br /> CITY OF ORONO� - BUII�DING PERMIT APPLICATION <br /> All information must be submitted in full before plan re�iew will be started. <br /> � (please print all information) <br /> THE APPLICANT IS: (circle one) OWNER CONTRACTO <br /> � <br /> JOB SITE ADDRESS: �Z�� CO�^�-j 5' ��: �"� ZIP: <br /> -. ^ <br /> NAME OF OWNER: ��r c' ��� ���S�n PHO\'E: (home) <br /> / (� (work) <br /> �IAILL�iG A.DDRESS: Z 67� �U�^�,�y S�f�r U.�; CITY: (��un o ZIP: . <br /> cozv�rxACTox: � � .�.��, �,� � � �� Pxo`�: �� Z- ��z-.�/�5 <br /> CONTACT PERSON: MOBILE/PAGE�:�Z � D <br /> MAII.I�i tG ADDRESS: ' �. i/ . CITY: � ' ch c ZIP: /�r/� �j���� <br /> STATE LICENSE: # )�v j `3,r 5 �3� <br /> ARCHITECT/ENGINEER: �, /��c��� PHO\"E: �(Z 5�I J- 3 60�J <br /> MA.ILING ADDRESS: CITY: Z�: <br /> N�,�; REGISTRATION# � <br /> ��� � ��/ <br /> TYPE OF WORK: New Addition %� Accessory Structure <br /> Move Remodel/Alteration Land Alteration <br /> � c�i�ci2 � � <br /> PROPOSED`VORK (describe in detain: „ �� <br /> STORIES: SQ. FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS: GARAGE STALLS: ATT. � DET. <br /> ESTL�IATED CO�'STRUCTION VALUATION (excluding land): � ���'�' <br /> I hereby apply for a building permit and I acknowledge that the information above is complete and <br /> accurate; that the work will be in conformance with the ordinances and codes of the Ciry and with <br /> the State Building Code; that I understand this is not a permit and work is not to start without a <br /> permit; and that the work will be in accordance with the approved plan. <br /> � <br /> APPLICANT'S SIGNATURE: � �^�'"� DATE: � � �� <br /> NOTE! Parade of Homes events require separate permit approyal by Police Department and <br /> City Counci160 days prior to the event. Non permitted events will not be allowed. <br />
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