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CITY OF bRONO -�,BIII_T�ING PERMIT APPLICATION <br /> '?'otal Fee: $ �'� �- � � Date Received: <br /> Date Approved: <br /> Entered By: ��� . <br /> .� 1 �' <br /> "' Permit#: �'�' <br /> AT•T• INFORMATION MDST BE SIIBMITTED IN FULL BSFORE PLP,N REVIEW WILL BE STARTED <br /> --------------------------------------------------------------- <br /> THE APPI�ICANT IS: (circle one) ER .,�r CONTRACTOR <br /> � <br /> JOB SITE ADDRESS: I `t � t t-�z:•�_�v���`� "� 1� �•, _ ZIP: �� �� � <br /> c <br /> (work) ��`�J c-,`� �-`� <br /> N�ME OF OWNER: �—�'•�``�r_i �'`'�- C�•.�c �5 ��2 ti•5 r%�. PHONE: (home) '`�7( � l �Z � <br /> MAII�ING ADDRESS: `"�r� �t=- CITYS l:t:'<<•�Z,-�.�Ct ZIP: 5 R�nc <br /> _� <br /> t <br /> CONTRACTOR: "�'/� PHONE: <br /> °�iAILING ADDRESS: CITY: ZIP' <br /> TYPE OF WORR: New Addition Accessory Structure Move <br /> Demo Remodel/Alteration_� Renovate Land Alteration <br /> ��'` � <br /> PROPOSED WORR (describe in detail) : Y�w��.:c., � = 7'.C-� �,vcrw <br /> STORIES: '� SQ. FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS:� GARAG$ STALI,S: ATT. .�' DET. <br /> �/ , <br /> ESTIMATED CONSTRIICTION VALIIATION (excluding land) : $ "7� �� <br /> I hereby apply for a building permit and I acknowledge that the information <br /> above is complete and accurate; that the work will be in conformance with the <br /> ordinances and codes of the City and with the State Building Code; that I <br /> understand this is not a Fermit and work is not to start without a �ermit; and <br /> that the work will be in accordance with the aF�roved plan. <br /> A,PPLICANT'S SIGNATQRE: `= � -c..-�,...�.,� DATE: l C�'c l �� � <br /> � <br /> (Please fill out the reverse side of this form) <br />