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f " d � <br /> � (� <br /> � <br /> Total Fee: $ �` , Date Received: ��!�/� <br /> Entered By: Permit#: 0�-DO <br /> CITY OF RONO - BUILDING PERMIT APP�ICATION <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: a.ya.0 L-�;, �.tiG<;�,� 1�\�}�i ZIP: >>���( <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? <br /> ❑ Yes �NO If yes, a special event permit is required with Police Departmenl 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-per�mitted events will not be allowed. <br /> NAME OF OWNER: (�,��,,,,T��u eMb,ro�:�AU ���'�� PHONE: (home)�(�j��c.{�( -SSI� <br /> (work) <br /> MAILING ADDRESS: �..�2'C -�vN wc,��y IQu v CITY: 5�,2,,^,t�t ZIP: 5S3cj� <br /> CONTRACTOR: TN� ��c���(�2� C�J������vb . iv,ii, PHONE: 9��-�G?L -�:71� <br /> CONTACT PERSON: �y� �����,�.; MOBILE/PAGER: (�c L-��hS�ak,c-I ti <br /> MAILING ADDRESS: �p�,c�,����y�;� t� CITY: V�L�.;.� ZIP: �S3E�'� <br /> STATE LICENSE: # �(,Lti EXPIRATION llATE: 3's�-•r°� <br /> ARCHITECT/ENGINEER: PHONE: <br /> MAILING ADDRESS: CITY: ZIP: <br /> NAME: REGISTRATION: # <br /> TYPE OF WORK: New Home Addition Accessory Structure <br /> Move Ho�ne Remodel/Alteration (ie: Siding, Windows)�_ <br /> Any earth movement may require MCWD review and permits ! <br /> PROPOSED WORK(describe in detai�: F-;��'�����ov� �� �i�Fc�'� <br /> STORIES: SQ.FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED <br /> ESTIMATED CONSTRUCTION VALUATION(excluding land): $ � oe�! ��� <br /> I hereby apply for a building permit and I acknowledge that the information above is coinplete 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'SSIGNATURE: � �,�r� DATE: L�-` �"��'�' <br /> 31 <br />