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TotAl Fee: S Da�ee Receivcd: <br /> Entercd By: � PermitM• ��______ <br /> CITY �F ORO►NO - 16UILLlING F�RMIT APPL,ICA'I`IOlY <br /> Ail inforxnateen must be suhmi8ted in full befare p�an review will be ststrtcd. <br /> (pdeu►se print aU infirrmatavn) <br /> THE APPLICANT iS: (circle a�ne) OWNER OR NT'RACT�(?R <br /> � <br /> dOBSIT�ADDRESS: I��'�„__C� F�C`� (f�� SS �{�: ��. �tP: S S :�� c� <br /> Will tfiis be a F�rade of Hoa�nes, Re�nnodelers �howcase Home or ot6er �►�splay Home? <br /> QY� �No If yes,n special event permrt as rzquired wi;h Pnlice De�rnnent anci Ciry Council a�rproe�rl <br /> 60 days}�sior to the event. Sjuettle bus service wilt be required unless appltcant demnnstrates <br /> sufj"7cient on-site purJung as availabte. Non-permined events will not be aJlowed <br /> NAME OF OWNER:�N �<<�1��if�-��c=�C'1�-- PHONE: (home) <br /> (�'�)__.� <br /> ?�I�ILIriC ADDRESS: CIT4': �iiF': ___�___� <br /> +l:'ONTRACTUR:��1.�, �1� ��� �;v���ft;r�ira�ti' PHOP�E:��S�'-�'7J--�Ss' � <br /> COIYT'ACT PERSON: R��1� MOBILE/P.4G : � J,��f E 7�3i � �_ <br /> A�IAILING ADDRESSzb�<3� =�- 5�,�;.�c-ns L�r- �/'. CITYi��NdvcTf; ____�__y <br /> STATE LICEP35E: !{ 53r�`j � EXPIRATt01�DATE: �3 -�� -•��`�" <br /> ARCHITECT/ENGIlV�ER: ____, PHONE: �„ <br /> MAILING ADDRE55: CTTY: Z�P: _,,,� <br /> NA11�dE; REGISTRATION: M �_____i___. <br /> TYPE OF WORK: N�w Hoxne _ Additio�n _ ?�ccessory Str�cture <br /> Move Home T R�mode(/Al;erarion(ie: Siding, VJindc�tivs� _ <br /> Any earth mr�vemen� rray require MCWD eview ancZ permit�i <br /> PROPOSEA WORK(des�ri�be ia de�trei�p:���(,a�� l3����t_<,.. �?�7`t�s� t�e c�l�l�./ <br /> Nd�� '\� �1.���"Gt+nc�P - R.c vv��v r -���ac� � �S'� G-_��. Jr' - 12� -��. Lo w Gf�' <br /> ���� � �c� vs-L <br /> S'TORIES: �.�EET UF EACH�'LAOR: <br /> NO. OF BEDR40MS:,_ GAItA.GF S I'ALLS: 4TTACHED i?ETACI�ED� <br /> �c� <br /> ESTIMATED CONSTRIIC"�'ION VALiJATION(ezciuding land): S '-1 ,,,�_�-� <br /> I hereby a�ply far a buiid:np,permit aind I acknowledg�:th�ai the snfurmat�on abovc is complete ar�d accuraie; <br /> that the work will be in�nforrnanc,e with the aedinaraces�nd codes of the City arid with the State Burfding <br /> Code;tliat i understand this is not a�Sermit and work i s not to start v�nthout a per�r►it;and that 4he work w:il be <br /> in accorda�ce with the approved piara. <br /> A1-� .7 <br /> APPLI�CANT'S SiGNATURE: /�'�'- � DATE» � -�� � <br /> 3l <br />