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CIZ*y pF ORONO - BQII,DING PERl�LIT r�PPLIC�TION <br /> � <br /> � ,� �, Date Received: 1l ' � - `1 <br /> Tc�ta1 ree: $ `' i/' h - <br /> Date P.��roved: <br /> �ntered 3v: � i�i _ Per�it;- -,�'� <br /> .�._ <br /> r�L INFORMATSaN MIIST BS SITBMITTED IN F'UI�I' BEFORE PI�'�N REVIEW WILL BB ST�R`��.D <br /> (See Check-aff List Enclosed) <br /> ------ <br /> -------------- <br /> � APPLICANT IS: (c=rcl.e ene) <br /> WNER r CONTRACTOR <br /> JOB sz� �Dxsss: �\� �-�.� �...�c� �o �l2co�o zzP: �5��-� <br /> (wor�c) ��Z.- \Z�CD <br /> f� PHON�: (home) �A��" <br /> N�ME OF O WNL'R: �E.�`Q-�E. 1-t�P�.�2���� <br /> HATZING ADDRESS:�\��i �\���� � CSTY: Q�f.� <br /> Z Z P: ����-�-- <br /> PgorrB: <br /> CONZ'RACTOR. EL-F - ��•��Q'�. <br /> ?�+lAIZING ADDRESS: <br /> � CITY: ZIP: <br /> ST�,TS LICENSE: T <br /> PHONE: <br /> AR CHI TE C T/EN G INEy.t2: <br /> �ATT•ZIJG ADDRESS: <br /> CITY: ZIP:. <br /> RSGISTRATIOA = <br /> N�ME: <br /> TYPE OF WORK: New Addition� Accessary Structure <br /> Move <br /> Demo Remodel/Al.teration� Renovate Land Al�eraticn <br /> PROPOSED WORK (des�ri.be in detail) :�� <br /> S-c�..s.� A-oo,�o� ��--�.�.�E� p a.�s�.� <br /> R�rn���. C�S��za ���(�.O � �LOtJ��R.�.`C��4� � �At1�c.� <br /> 2 SQ. FEBT OF EACH FI�DOR: \�P\� �S Le�--_;/ �� � O`� <br /> STORZES: � <br /> HO. OF BSDROOMS:_ � GARAGS ST1�I.I�S: ATT. DET.�'� ¢��, <br /> e� <br /> ESTIHATE'D CONSTRIICTION VALIIATION (eacluding I�d) = $ �, <br /> I hereby apoly for a building permit and I acknowledge that the infor�ztion <br /> above is complete and accurate; that the work will be in confor.z�anc� with the <br /> cr3inances and codes of Cit and with the State Building Co ee�i�aa�c <br /> understand this is not a erm ' an work is not to start without a p <br /> t�at t h e w o rk wiil be i acc d ce h the approved plan. � <br /> APPLICANT`S SIGPIATIIRE: <br /> DATE: \� � ` <br />