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` � !�- � Date Received: � y-��'�� / <br /> Total�ee: $ � G' � <br /> Entered By: � Permit#: /f `���`� � <br /> ,!/ � � <br /> CITY OF�ORONO — BZTII�DING PERMIT Al'PLICATION � <br /> A.11 informa�ion must be submitted in full before plan revie�v���ill be started. . � <br /> . (please print all information) . : . <br /> _� - . � . CONTRACTO' . - <br /> 'I�i-iE AP?LTCAN'I` IS: (circie one) . �SVNER O ' . <br /> J�s <br /> SITE A.DARESS: 1 '� . , �r LK� ��, z�: S���l J _ ; <br /> 1, 1 _, -�� <br /> NA11�SE OF Oti'Yi�►TER: ��fl MG�� .� (,�1��C'(,�E!'\ PHO��: (home) �� i � C <br /> . � (work) <br /> IYLAILI�i G A�DF'•ESS: SiR r�� CTTY: ZIP:�_ <br /> � c�cox: ,S��� �� i�'�. � ��-�M.S 1 J�. PHo�: �17-07�'� <br /> co�x.� <br /> CON'TACTPERSON: �) �/ ''�` v�' MOBILE/PAGER �� ._ 7C� S�`� <br /> MA.L�L,ItiGA.DDREss: 1 � ��� �Gl A ' C�' �1��'���v ����� �� S�-. 3rJ7— <br /> STATE LICENSE: # D � <br /> ARCHITECZ'�ENG .Itii TEER: . � PHONE:. �� <br /> i1�II�'I�i'G ADDktESS: CTTY: ZIP: <br /> � A�,�-�+ gEGISTRATIO�I# <br /> 1\Tti.t1'��••: <br /> s � <br /> TYPE OF �'YORK: New ���� �'S''��'Addition Accessory Structure <br /> Move Remodel/Alteration Land Alteration _ <br /> � � tG i ����Il l��hb�r �lo; �daf on h���se <br /> PROPOSED ti�ORK(describe in detai�: �� <br /> Va � '� � �i �,�- �- � hD s�� r�1�.�16�� <br /> � �,�:�hl� `� li)C f�on' ' � � (�IVC 5it�i11� ��� ��R��.l�b�= <br /> � <br /> STORIES: SQ.F'EET OF EACS FLOOR: <br /> i\O. OF BEDROOMS: GARAGE STALLS: ATT• _____ DET. . . <br /> ESTIitiIA.TED CO <br /> NSTRUCTxON VALUATION (excluding land): $ ��� �'�C _ � <br /> I hereby apply for a building permit and I acknowledge that the information above is complete and <br /> accurate; that the work will be in conformance with the ordinances a.nd codes of the Ciry and with <br /> the State Build�n� Code; that I understand this is not a permit and work is noc to start without a <br /> permit; and thac the work will be in �ccordance with the approved plan. <br /> ` � ' ��� ��� D��: � ' �� " �� <br /> t � U����. � <br /> APPLICA�\"T S SIGNATURE• <br /> NOTE! Parade of Home� events require separate permit approvaI by Police �epartment and <br /> � City Counci160 days prior to the event. Non permitted events will not be allowed. <br />