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� /4 <br /> , .� J ' '!�� �' _ <br /> ( <br /> Total Fee: � - � Date Received: � l C/ <br /> Entered By: �'�',� Permit#: > � /�=>" <br /> „ , � ,� <br /> � c � ,y ,�—, `�' ... �— �,� <br /> CI� �?� 03�ON0 - BUILDII�TG PERMIT A.PPLICATION <br /> A.11 information must be submitted in full before plan review �vill be started. <br /> ' (please print a11 information) <br /> THE A.PPLICANT IS: (circle one) O��NER R CONTRACTOR <br /> JOB SITE ADDRESS: �5�S i�,i n ri t�.... �.7 E- ZIP: 5���l�� <br /> �S�y <br /> NAME OF O��NER: ,�t0.r��2. �u.r� ��� PHOi�TE: (home) �'S��-'�?!� <br /> (work) <br /> 1�I.A.II..Pi tG ADDRESS: ���S rti�t��n;�� /�v� . CITY: �k�e,r-�c zIP: �5`.�t� � <br /> CONTRACTOR: " PHO��: <br /> CO�tTACT PERSON: �IOBILE/PAGER: <br /> NIAILING ADDRESS: CTTY: Z�� <br /> �TATE LICENSE: # <br /> ARCHIT`ECT/ENG�'EER: PHO\rE: <br /> NIAIL�'G ADDRESS: CITY: Z�: <br /> �T��,�; REGISTRA.TION# � <br /> TYPE OF �i'ORK: New Addition Accessory Structure ➢� <br /> Move Remodel/Alteration Land Alteration <br /> PROPOSED�VORK(describe in detai�: ��` x �4� � ��r��' ���=k �'�`' ��0�'� ��� �`��s� � <br /> STORIES: SQ. FEET OF EACH FLOOR: <br /> NO. OF B�.DROOI�IS: GARAGE STALLS: ATT�. � DET. � - = - � �� ., <br /> ot� <br /> ESTII�i IATED CO`'STRUCTION VALUATIO\ (excludi.ng land): � ���� <br /> I hereby apply for a buildin� permit and I acknowledge that the information above is complete and <br /> accurate; that the work will be in conformance with the ordinances and codes of the City and with <br /> the State BuildinJ 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 a rda 'ith the approved plan. <br /> � z <br /> APPLTCA.���T''S SIGNATURE: � DATE: � — <br /> � ,-�� ' � <br /> 1�'OTE! Parade of Homes 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 />