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� •� CITY OF �RONO - BIIZLDING PERMIT APPLICATION <br /> i <br /> Total Fee: $ ��.�5 Date Received: <br /> Date Approved: <br /> Lntered By: ' <br /> Permit�: �J' �I a�' <br /> ;�7•T• INFORMATION MIIST B$ SIIBMITT� IN FDLL BEFORE PLAN REVIEW WILL BS STAR�ED <br /> (See Check-aff List Enclosed) <br /> -------------------------------------------------------------------------------- <br /> '�'HE APPLICANT IS: (circle one) OWNER or CONTRACTOR <br /> JOB SITE ADDRSSS: U�� � (� �� s � ZIP: <br /> (work) <br /> i+1AI�: OF OWNER: I e � 7 �D a w eh PHONE: (home) <br /> MAILING ADDRESS:� l�J C�Qk ST CIT�:_11� ra n D ZIP: <br /> CON�c�roR:� / ��rs �� --� S o� s i�d C. pHOxs: /—��„? -� 7/ C� <br /> �ATLING ADDRSSS: � 6"�C [� .� � CITY: � e- ��r n n ZIP: .5.53 0�- � <br /> STATS LICENSE: � 0 Q6 �a- � n <br /> �RCHITECT/SNGINEER: C I�' ��--� Y� � o r �r, ,6 rc� .� PHONE: L�7� - �����— <br /> MA TLING ADDRSSS: �l.p.� �'u�h� .�.��_� � V C' CITY: �6�-,ci �a �t F ZIP: .3J 3�� <br /> ry�: R$GISTRATIOP � <br /> TYPE OF WORR: New Addition� Accessory Structure Mone <br /> Demo Remodel/Alteration Renovate Land Alteration <br /> PROPOSED WORR (describe in detail) : N 6'EY so� �a r c � o •� uJ o �� C d/�°��S <br /> STORI$S: SQ. FEBT OF EACH FI�OOR: ��� s' ,Q �j- � <br /> NO. �F B$DROOMS: GARl�GS STALLS: ATT. DET. <br /> ESTIMATED CONSTRIICTION VALIIATION (eaclnding land3 : $ q„f�ttJ � <br /> I hereby apply for a building permit and I acknowledge that the information <br /> above is complete and accurate; that the work will be in conformance with the <br /> ordinances and codes of the City and with the State Building Code; that I <br /> understand this is not a permit and work is not to start without a permit; and <br /> that the work will be in accordance with the approved plan. <br /> APPLICAIJT'S SIGNATORE: ��CC/� hJ• � DATE:��-- �7�� <br />