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Total Fee: $ i�,� � �C DateReceived: /�� ����_ <br /> Entered By: _ �r_� Permit#: /�� i��=�—� <br /> �'I�'Y iv� Q�I�GPv� - �u IL�iI�1cT r�,R�i 1 APP�.I�A 1 IGIv <br /> All information must be submitted in full before plan review will be started. <br /> (please print all information) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> THE APPLICANT IS: (circle one) OWNER O CONTRACTOR <br /> Jos siTE ann�ss: 13 7 u IVc�S'-��1 {��m �'r Ue z�: �'S3 �� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? <br /> ❑ Yes �O Ifyes, a special event permit is reguired with Police Department and City Council approval <br /> 60 days prior to the event. Shuttle bus service wil!be required unless applicant demonstrates <br /> sufficient on-site parking is available. Non permitted events will not be allowed. <br /> NAME OF OWNER J U �Q, V 1 ` �Q`T`Q �D� PHONE: (home) y S�!�� I '0�l�{ <br /> (work) <br /> MAILING ADDRESS: � 3�O �. �f!� J�� CITY: �D U Sl� ZII': �$''S3 ��/ <br /> CONTRACTOR• THD At-Home Services, Inc. PHO�• �S� �S„ • G0�7 <br /> CONTACT PERSON: Dba The Home Depot At-Home Services AGER: JU C� i N �1 C�l(` 0/U. � <br /> MAILING ADDRESS:— 3200 Cobb Galleria, Suite #200 ZIP: <br /> STATE LICENSE: # - Atlanta, GA 30339 DATE• <br /> — License#20268257 - 763-542-8826 <br /> ARCHITECT/ENGINEER: PHONE: <br /> MAILING ADDRESS: — 1� CITY: ZIP: <br /> NAME: REGISTRATION: # <br /> TYPE OF WORK: New Home Addition Accessory Structure <br /> Move Home Remodel/Alteration(ie: Siding, Windows) - <br /> Any earth movement may require MCWD review and permits! <br /> PROPOS D WORK(describe in cletai : � or c h �� CfOl,v �� �� ��� <br /> ^ �V/�l!' /�0 vi'� �� � <br /> d�� n��� <br /> STO ES: SQ.FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED <br /> ESTIMATED CONSTRUCTION VALUATION(excluding land): $ -1', �� � <br /> I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; <br /> that the work will be in conformance with the ordinances and codes of the City and with the State Building <br /> Code;that I understand this is not a permit and work is not to start without a permit;and that the work will be <br /> in accordance with the approved plan. <br /> l � <br /> APPLICANT'S SIGNATURE:� DATE: �j I� � <br /> 31 <br />