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F��7M :rEALGUARD FAX N0. :6514813939 Sep. 12 2002 02:59PM P2/3 <br /> • s.p-12-2o0t 01:aaam From-ciTr oF o�ono �A622494818 T-028 P.001/002 F-012 <br /> /��(� Tot�l Fee: $_„a v o, o D&ts R�eivcd:`y-/�_ o� <br /> � �1 �ntered By, m, Permit�: ��0 5-6 o g <br /> � CITY 4F ORONO - BT.TYLDIlVG PTRMIT Ap�i.�TCATYON <br /> All informatlon n�u�tt be submitted In fu]l b�efora plan review wfll bo�tar��ad. <br /> (plet�r.se print all ir�formaiion) <br /> ____.�.._..___.,T_-----------�...........----------------- ..._. _��.....�------, <br /> TH� APPIeICA1VT I5: (circle one) O'VVNER CON'Y'1ZA,CTpR <br /> .ro� srr� an���;ss: ���� �C� �� : SS��i 1,�,_. ' <br /> rr� o�owx�R: .-�,,UI,V�1,S�0��� � �o�: �no�� ��l�-UT13 <br /> r- ( rk) _ <br /> �nvG�nn�ss: _�, �C� e,� h�S� . �i�rY: 6�n v z�: l <br /> �r�rrr�croR: r�arrE: loSl y�45\ Z�� <br /> CONTACT FER�UIV: C (�J MOBI'T..�/PAG�R: <br /> MA]LIl�TG ADDRE�S:'3`�� > > �,Yl O�,b '�(�'l`1 Cl7'Yo xI�: SS 1 1 <br /> STA,TE LYC�NSE: ��x�����d <br /> ARC�C'Y'I�CT/FNCZN��.R: PHOIV�: <br /> MAILIN�s ADDI�SS: CiTY: ZII': <br /> ly'AlVl�: �[�ISTItATYON� <br /> TYPE 4F WORg: N'ew Addition Acc.���QKy►Sttuctiu.te <br /> Movc RemodeUAlteration La�d Alteration <br /> PROP03�D WOItK(dGscr'W s�ic deta�n: YT - - � � U.��V l��� <br /> STORIP�a: SQ.F�ET OF EACH FLOQR: <br /> N'O. OF BEDROd1ViS: w__r__ CARAGE 5TALLS: AT�', DET,,_„�„ ' <br /> ESTIMATED CdNSTRiJCTION VALUATION(�excludtn�lantn: � �� �7-,U,Q� , `�� <br /> I hereby apply for a building pcmliL a�d I aclocwwledge tl�t the in�ormation above is eomp�e�e a�d, <br /> accurare; t11at rhe work wi11 tie in conformance w�th th�e ordfnances and eod� af the Ci�ly�nd with <br /> the�tate Auilc�it� Code; that T underatAs�d this is not a pernais and work is not to st�,rt vVit]3out a <br /> � permit; auc�that the work wfll be i�n accordat�ce with t'hc appcaved pl.an. <br /> A�`PLTCANT'S SYC'rNA . V�I�. . (l� DAT�: "�^ l� ' �� <br /> ND?'�c! Parad�pf�p���yents require separate perrntt a,pproval by Fol�Ce Depu�tnient artd <br /> ' Ctty Counc�C 60 days pr�vr to th� eve,rt. N'on per»iitted events will�ot be atXawed. <br />