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CSTY 8F�NO - BIIIZDING PERMIT APPI,ICATION <br /> Total Fee: $ y.3� � v Date Received: <br /> Date Approved: _ <br /> ' Entered By: ,� '1/� ,h 0 q � <br /> Permit�: <br /> AI,I. INFORMATION MIIST BS SIIBMITTED IN FIILL B��� P�N �v=� �� B$ STARTED <br /> (See Check-off List EncI.osed) <br /> -------------------------- <br /> THE APPLICANT IS: (circle one) OWNER or CONTRACTOR <br /> � JOB SITE ADDRSSS: ��02� !I/Dr�� lrfrm ///�� ' D ZIP: <br /> (work) <br /> NAME OF OWNER: ' � PHONE: (home) _ <br /> M�ILING ADDRESS: CITY: ZIP: <br /> �L� S' � � .� � � P$o�: �'�,���ys 8�60 <br /> CONTRACTOR: 2 PS <br /> MAII�ING ADDRESS: / �� CITY: �� Is 4 r/� ZIP: ��y/•Z <br /> STATE LICENSE: #����7� <br /> ARCHITECT/ENGINEER: PHONE: <br /> MAII,ING ADDR$SS: CITY: ZIP: <br /> N�: REGISTF2ATION A <br /> TYPE OF WORR: New <br /> Addition Accessory Structure Move � <br /> Demo Remodel/Alteration Renovate Land Alteration <br /> . <br /> PROPOSED WORK (describe in detail) : a �� <br /> �,�.�� � ��� S, '� / � <br /> STORIES: I S - OF �� �'�R" <br /> NO. OF BBDROOMS: GARAGE STI�LLS: ATT. DET. <br /> ESTIMATED CONSTRIICTION VALIIATION (eacluding land) : $ / / �� �� <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 Wi�hathI <br /> ordinances and codes of the City and with the State Building Code; <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 /> APPLICANT'S SIGNATDRE: DATE: y��7� <br />