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FROM :Asphalt Specialties FAX N0. :6514848063 Sep. 02 2003 09:33AM P1 <br /> � - ' (� �� PE�lih't C i /�c��r�� - ��-�� �' /�N�r t� S�, P (/' <br /> (�.lfl S 0.1� Tp �,�c� ��= s" ' �/�P e'L� L�,,,� �`. �s � <br /> Total Fee: $ � Date Received: � <br /> Entered By: Pemiit�#: ,I:S-3 •a 3 <br /> CITY OF ORONO - �BUII.DIl�tG.PERMIT APPLICAI'YON ' <br /> . : <br /> ; <br /> All information must <br /> . be submi{tied in fu11�b�efore:pIan-�eview:w�L.be.star.t.e.d..,,._, . <br /> � (please print all.informatian) - <br /> . . : <br /> T� APPLICANT IS: � (circle one) OWNER O ONTRACTO � � �� � � � <br /> JOB SITE ADDRESS: /�O he-� . �,G� ZIP: SS:3.� <br /> NAME OF O'WNER: � �- G%r��S PHONE: (home) 9s.Z-��c�-!��'1 <br /> (work) <br /> MA.ILIl\'G ADDRESS: �9v �,, �� �L. . :CTTY:... D�o�,a ZIP: S ' <br /> �5;': <br /> CO�iTRACTOR:�T��pt-�,.l�.�eLi� l�'�.O PHONE: (��"/—�-/�`�-!�5'Co . <br /> CONTACT PERSON: �;� MOBII,E/PAGER: <br /> MAII,ING ADDI2ESS: 5�i�� G� fr{L,���'�.TT CITY: � <br /> S�,o.�� .zIP: ss r� co <br /> STATE.LICENSE:. #.. 51.3 22 . <br /> ARCHITECT/ENGINEER: � PHONE: <br /> MA7LING ADDRESSi - <.: , . :: : ,CITY: .. . ,:... ZIP: <br /> NAI�: � . - . REGIST�2A,TION# . <br /> TYPE OF WORK: New Addition�, Accessory Structure <br /> Mo've � RemodeUAlteration Land Altera�ion <br /> PROPOSEA WORK.(describe.in detai�: -�G�.oF o,� -�v . �k�'s-� �.Q .D r;;�� <br /> STORIES: 5Q.FEET OF EACH FLOOR: <br /> NO. OF SEDROOMS: . � . . . . GARAGE STALLS: RTT. � DET. <br /> ESTIMA.'I'ED CON'STRUCTION VALUATION (excluding land): $Lj S'�-�`'� . o� <br /> Y hereby apply for a building permit and Y acknowledge that the information above is complete and . <br /> accurate; rhat the work will be in conformance with.the ordinances and codes of the City and with <br /> � the State Building Code; that I understand this is not a permit and work is not to start without a <br /> perinit;.and that�the.work will be in accoidauce with the�approved plan. - � . .. � .. � <br /> . . , .... . <br /> . . ... . . <br /> . ..... <br /> _ <br /> . . <br /> APPLICANr'S SIGNATYTRE: � �. ��DATE: � 2 � 0� <br /> NOTE! P�zrade nf]Yomes events require separate permit..appraval by Police Department and � <br /> City Counc�l 60 days prior to the event. Non permitted eveRts will not be allvwed. . <br /> �_� ,, Qr� �u��cii�� <br />