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f <br /> Tot�.l Fee: $ Date Received: <br /> Entered By: Permit#: <br /> CITY 4F ORONO - BUII.DING PERIVIIT APPLICATION <br /> All information must be submitted in full before plan review will be started. <br /> ' (please print a11 information) . <br /> ------------- ----------------------------------------- - -� --�_---- ---------------- <br /> THE AFPLICANT IS: (circle one) OWNER O NTRA.CTO � <br /> JOB SITE ADDRESS: �//�� ,�/,ri� ,,�ool� � — Z�� <br /> NAME OF OWNER: PHONE: (home) <br /> (work) <br /> 1�IATI.ING ADDRESS: . CI1'Y: ZIP: <br /> CONTRACTOR: ' [GL� �LLL- c, PHO�IE: �o I�'7O I��$�I� <br /> COi�I'I'ACTPERSON: /�'16��2K l� 1�IOBILE/PAGER: �( /�.-1a70- 2�oY^? <br /> MAILING ADDRESS: /�D� �(1C(��� � __ CITY:�/'t,�vE,��` ZIP:��3d� <br /> STATE LICENSE: # C-` ��`I I <br /> ARCHITECT/ENGPi IEER: PH0�1E: . <br /> RZA.IL�G ADDRESS: CITY: ZIP: <br /> Nr�,ME; REGISTRATION# � <br /> TYPE OF WORK: New Addition Accessory Structure <br /> Move Remodel/Alteration � Land Alteration <br /> PROPOSED WORK(describe in detain: �� O�f 2�'D l �' Srt����� _ <br /> STORIES: �_ SQ.FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS:� GAR.AGE STALLS: ATT: - DET. , - -�•.:.-� <br /> _ a- <br /> ESTLI�ATED CONSTRUCTION VALUATIO\(exclud.ing land): S �l/��� <br /> I hereby apply for a building permit and I acknowled?e that the information above is complete and <br /> accurate; that the work will be in conformance with the ordinances and codes of the Ciry and with <br /> the State Building Code; that I understand this is not a perm.it and work is not to start without a <br /> permit; and that the work will be in accordance ith the approved plan. <br /> APPLICANT'S SIGNATURE: � DAZ'E:� ���D / - <br /> NOTE! �'arade of Fiomes events require separate permit approval by Police Department and <br /> City Council 60 days prior to the event. Non permitted events will not be allowed. <br />