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$ 3 �9• Oa Aste Received: ' - -O <br /> Tatal Fee: ' Q Permit#: �'o�i-� <br /> fi�er�d BY; - <br /> f ^� CIT'Y�� OROND -BUII.DIlYG PF.RM�'r A�'PY.YCA'TYON <br /> � � �� on must be subm�tted iu ft�l!b�!'ore plan re�vi.ew will be started. <br /> � � . A1l�orntaH ° - <br /> (Fkase prtnt ai1 fn�'ormation) <br /> V,r,� ---._.._..�..r...w_�---- ' •----------�-_"�_' . <br /> _..._.....----------------- <br />����; 'Y`SE AI�LICANT IS: (circle ane) OWNER O C4N?RACTO <br /> JOB SIT�AD�?RESS:� D� �� Zg': ��� ( <br /> . � �o�� Pso :��o�c�� 4� �Z� �� <br /> NAN�4F OW'NER. Ol �. �� � _ � <br /> ,�,�,,a�,nv��u»�.ss: l er . crrx:..Q��:�5 1- <br /> co�c�cox: � Clo.�i� o � l • �orn�: �i�32-S�IS `12t� <br /> CONTACT PERSONi � l�lOA1L1f��V�• ��r�.r <br /> MAIL,Il�IG ADDRESS: 1'LQOo �� �'-`�� <br /> �pTE LICEN3E: � 2.o�.p( �_ <br /> - �C �R; PSOI�'E: _ - . <br /> 1NIAZLII�'GADDRESS: CTl'Y: ��_ . <br /> NAiVtE: YSTRA�ION tf <br /> TYX'E OF WORK: New` Addition� A�as�rY S�Nre--- <br /> Move,�„ Re�ocleUAIteradon,� Land Altorat'son_,�,_ <br /> pgOpOSED WOYtA(describe tn detain: � � � ��`'�� <br /> e. � <br /> S`TORII'S: --- 9Q.�"EET OF EAC�FLOOR: . .. <br /> NO. OF BEDROOMS: GARAGE STALLS:��TT:,�,�,; DS'�.�:.� ... ., . .° <br /> FSTIl4�iTED CONST1ttTJCTION'VA�,UATION �exdudtng land): � � ��� • �� <br /> i ber+eby apply for e building permic and I ackaowled�e thaz th�iaformation above is c4mplete and <br /> accurate;that the worY w11i be in canformaa�e wit�t]oe ordina�ces and codes of t�e City aad aicb <br /> t�e State Bu�lding Code: tbat I und�rstand ffiis is not a pecmit and work is aot W start w.ithaut a <br /> pern�ic; and that the work will be in acco�.daace wi the a roved plan• . <br /> APPLTCAN'�"S SI�1�A'FIFRE. 0. . DATE: � 0 � <br /> NOTSf ���'i'e►r!s requfre separwte per�n�t approval By Pai�ee DepanA►nent an� <br /> � C�y CouAcil 60 dayS Pr�w'r te the e�'ent. Non permitted events will Rot be ciIIowed. <br /> z 'd GGT99890b6 ` �NI S�0021 �ISSd�� dE0 �z0 TO EO I�C <br />