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�3:'�5%"�1 11:51 THE CIT`r' UF ORUtaO 612-47�-7��7 GGF <br />� , GI�X QF QRQNU - BIIZ�?IN� PERMIT APPI�IC11TIdH <br />' '�otal Fee: $ / �� ��' Date Received: <br />; <br />� -- <br /> 1 . Date Approved: <br />? Entered Hy: ���%' <br />` Pezm�.t #• 3 S� � � <br /> ALL INFQR.t�ATIQN MUST BE SUBMIT�D IN �`ULL $EFORE PJaAN RStIYB"W WII.L SS $TAR�'LU <br /> (Se� Check-off Lis� Enclosed ? <br /> -----�---------------���------�__�-�--------- -�-���-------------------�--- <br /> -------- <br /> T� APP�,ZCANT IS: . (cir�l� One ) OWNER or bNTRACTdR� <br /> � _ -- <br /> JOA &ITS ADD1tBSS:����- -1�1 ��.I p L.�! ------ �zP: �S�S� <br /> (work) � <br /> NAt� OF OhTt�IER:�R--.'Pr06�� � nl� ���fl�R�JR-C� pgoxE: (hdme ) `�1,�-�'!`��S_-- <br /> MAI�,ZNG ADDRBS3: G71�'�� �S CITY: Z�P: <br /> ����� <br /> CONTRACTOR: • LO'(z�P- PHC7NE: �?j8 "�� <br /> IytAZLING A1�17REs�: '�J`�7no $k����� � CITY: ��'� ZIP: SS �� <br /> . -- ,� , <br /> T3CPE QF �QRlf: New Addition AGcesso�y . Structui"� Mpve <br /> Demo Remoc�/Hl��r�t�c�n� Renovate�� L�nd �eratian_� <br /> PROP4SSD WORIi (describa in det�i.l) : �'F'�� � �%f�(�.�4t� ��'DT�►� - Il�•.�.L)O�+�l� . <br /> �Il�l� $pF_�I'�/�lT+ uP� _,od�� �I '., � ``�►D� I�t��,_.. <br /> $TpRI�S s S�. 1*EET OF EACH FL(30�t: __ <br /> NO. �F B$DRt7�MS s �AFtAG� STA?�LS: ATT. 1�ET. . <br /> BSTIMATED COIIS�OCTION VALOATIbN (excZud�ng Zand) : $,^��}�D� _ <br /> I h���by apply for a building permit and I aCknowl�dge th�t the information <br /> above i.s camplete and accuxa�e; �ha� the wosk will be in conformance wfth the <br /> Ordinan�es �nd God�s ot Che City and with t2i� S�ate Buildfng Code; that I <br /> understand �his ia nat a pez�mi� and wazk is riot to s�art wfthauti a permit; and <br /> tihat the work wiI l bei�n � sdan with �,he appraved p].an. <br /> , � � � <br /> APPLICAHT'S SIC'NATQRS_ � �----' DATE_ � �-?�, <br /> �— <br />