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•- c;.tl'Y U� UxUIVU - x�tJ�l;�iNG ��RMIT APPLrCATY�N <br /> 'Tota� �"cc: � '"/� -; , Date RG��i.ved: <br /> Date Appzoved: <br /> �ntered By: ' /� --- , ._ . <br /> Permit�t l ��''���� <br /> �L Ir�FukMhTIt�2i MIIST BE £IIBMITTF.I� ll� kul.l. t3�=n'ORE FLAN REV��W WI71L BS S�ARTED <br /> (Se� Check-Off L�,�� Encic4pc�) <br /> `l''rri,rA�P��it'•i+?�'Z' Z�: t��iY�:�1�- �_31i� )����4�FlJER�x' C�NT�CAC�Tuk----•.........�....._---------...�_...�_ <br /> .Tf�F1 ^T'I*F. ADOR$�:�: ,�" ��. `st_.� . �f14.�}�-,_, 2IP± �Yl � �� t - <br /> {wgrk? -?�� 0 S�� <br /> (� /� . <br /> N.�sI►� OF OWNL�R: ��N� �- �/'�C''�\``�--'I'�'' PHONE: (hom�►) 7 C� <br /> I.� � <br /> FSia�LI2iG ADD1iL'uu: � ,�1 `��G-(�� � _Q ��Q�'���„_,����r�T v '1+IP- £ J <br /> CON'T'RAC'Y'OR: cs w f� .r-.-.�'�--- Faorr$: �--�— <br /> �nTLI?q� ��.DDRESS: CITY: 2IP; <br /> STATS L�CEZiS$: # <br /> ARCHYTECT/ENGINF.ER: PH�NE: <br /> MA77�ING ADDRSSS: Cxx'X:_ ZxP: <br /> IJ�: l�GYSZ�tATION � ---- ---- <br /> TYPE OF W012K: New� Addi��.on Accessoz� S�ructure Move <br /> Demo Remodel/AYter�tion �� Renov&te L�nd Al.tex�ation <br /> �' � w <br /> pROPOSED WORR (descri.b� �u d�tail) : � �-�� i�� � �� �� <br /> STORYSS:---- . SQ. F�RT OF ��8 �OOR; <br /> Nd. dF B�RQQMSs GARAGS STALLS: ATT. DET. <br /> ' ( C� Q �7 .. �'� <br /> ESTIMAT�D CONSTRUCTI�N VALIIATIdN (escludi.ng �and) : $ <br /> I hereby apply for a buiidinq permit and Z acknowledge that the infor;na�i�on <br /> above is complete and accurate; that the work will be in contormance with the <br /> ordinances and cades o� the City and with the 5tate Building Gode; that X <br /> understand this is nvt a pexmi� and wvrk is not to start wfthout a permit; and <br /> that the work wzll be in accardance with the approved plan. . • <br /> APPLICAN'i"S SIGNA'Y'URE: DA�: Ur� ���� <br />