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� <br /> I - <br /> Buiiding Permit Application # <br /> i�i� �i Date Received: � d/_ <br /> E e ed Permit#: �- <br /> Reason(�s� �or ��iia . <br /> s � <br /> � O ONO - BUILDING PERMIT APPLICATION <br /> Staff:�{ � �e�-��'�"�� <br /> ti�rlfm'm �4on e s�bmitted in full before plan review will be started. <br /> (please print all informntion) <br /> THE APPLICANT IS: (circle one) OWNER -CON CTO <br /> JOB SITE ADDRESS: -�-JlQ /��nv��� L� ZIP: 3.SG <br /> Will this be a Parade of Homes, Remodelers Showcase Home o other Display ome? <br /> ❑ Yes ❑ No If yes, a special event permit is reguired w' Police Dep tment and Cit Council crpprova/ <br /> 60 days prior to the event. Shuttle bi�s servic will be requir d i�nless ap icant demonstrates <br /> szrfficienl on-site parking is availnble. Non p •n�itted even rvill not b allotived, <br /> NAME OF OWNER: S��K' �d �r M��� PHON • ome) 9S-?- �i`-•��/� <br /> (work) <br /> MAILING ADDRESS: 309� �'�'�`���� CITY: �'Oi" ZIP: ,s3 <br /> CONTR.ACTOR: 17o�pN ','� �°�� HONE: ��3'S��-9001� <br /> CONTACT PERSON: � �v°'`�`�� �� M BILE/PAGER: �G3-3an- 90�.� <br /> MAILINGADDRESS: /��Cw'''� 9 � TY: ���^�°�N ZIP: SSKycI <br /> STATE LICENSE: # ..ZO GG�S EXPI TION DATE: �.3- o� <br /> ARCHITECT/ENGINEER: PHONE: <br /> NIAILING ADDRESS: CI Y: ZIP: <br /> NAME: ISTRATION: # <br /> TYPE OF WO . ew Home Addition Accessory Structure �C <br /> e Home Remodel/Alteration (ie: Siding, Windows) <br /> Any rth move ent may require MCWD review and permits ! <br /> PROPOSED WORK(describe �letcri�: N G'�✓ND �.2' x ,�5' ��Nyt Le�✓l�o sw�r��►s <br /> ��L <br /> STORIES: SQ.FEET OF CH FLOOR: �`�D s9 � <br /> NO. OF BEDROOMS: GARAGE STALLS: ATTACHED� DETACAED_ <br /> ESTIMATED CONSTRYJCTION VALUATION(excluding land): � � ��� � <br /> I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; <br /> that the work will be in conformance with the ordinances and codes of the City and with the State Bui(ding <br /> Code;that[ understand this is not a permit and work is not to start without a permit;and that the�vork will be <br /> in accordance with the approved plan. <br /> APPLICAlVT'S SIGNATURE: DATE: ���� �, <br /> �t - . <br />