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10/e5 2001 14:01 6128688846 ABC PAGE 01 <br /> �, `u���7Wl D6cP3.am Fr �ITY OF OR0�10 +951�484616 <br /> T-685 P.002/003 F�6�17 <br /> ••, — <br /> �otal Fee: � l��O ' .� Date Received: <br /> Y�� Eiit�ered By, Tz/-� <br /> � Permtt#: <br /> �� io/g -- <br /> CITY F ORONO — BUILDII�TG PE�t,MIT ApPLICATION <br /> qSZ���f �l�4f�� `�52 2�q—�d��� <br /> . � • All in�orni mi�st be submitted ia ft�ll be�ore plan review will be started.'�jc � <br /> �ilease prin�rtll i�formatz•on) . <br /> :�- - - ._._ _...____ <br /> . -...�_..,, � <br /> �A�'PLYC I8: -- ------ -. <br /> (circle ane) OVV1vER 0 CONTRAC'�'p <br /> aas sr.r�a,nD s: 35� t_� r,�� � zm: 5�3 <br /> �r�o�o : �i� rxorr�: �� Qs� ?J�/ury <br /> �iAII•rivGADD S: �iv�� ��k��� � ���3`��_ <br /> , „�, _� CTl'Y: ; <br /> . —�_ <br /> �(J�TRACTOR: ' c,.n, � � �.�ra�o��80NE: Z p .- � <br /> EONTACT PF�ILS N: o� MOBII,,EJPA TR: 3 - �(} <br /> N�AII.II�TG ADD � '' <br /> :�,2 ,'w It.� . CI'1`Y: Z�:�� <br /> STATE L�CENSE #Zo <br /> �tCY�TECT/F.1�T Il�TEER: PHCINE: . <br /> �VtAILII�TG ADD : �CI'rX: 7�: <br /> ��� REGISTRATYON� . <br /> TYPE OF WORS N'ew Addition� Accessory Smtcture . <br /> Mov � Remod�UAlttetation�_ Laad AI�eration",� � <br /> PRQ�:'O�'E�D VVO (descr�be in detai�: Qe.,,.�:.1��w.-,� ,� �� (�.- r� <br /> S'1'ORYE�9: SQ.FEET 4F��ACH FLOOYL: <br /> 1W'O. OF$�D�tO :� GARAGE STALLS: ATT. � ]�ET. Z <br /> ES'1`IMATED CO � STRUCTION VALUATION(excludiag Isucn: $J(�� <br /> I:hr,�by apply for a ildina pormit and I acknowledge that the iafos�mation above is com,plete aad <br /> aEciva�e; tha�the w rk wiU be iu confor�e with the ordu�nces a�ad codss oP the Ciry sud.with <br /> the State Building e; that T uaderstand this is not a permic aad work is not w start without a <br /> perm.�i; and rhat the work will bc in accorda.nc�with the approved plan. <br /> �1PPLICANT'S�I NATU}2E � DATE: Q . <br /> NOTls'! events require aeparute perneit approval by Potice Departinent and <br /> � City Council 6p d privr to the evenc. Norr permined evenrs will not be adlowed. <br />