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t <br /> . ' <br /> Total Fee: $ � ���� � Date Received: // �'�5'� <br /> Entered By: Permit#: C� <br /> CITY F ORONO - BUII.DING PERNIIT APPLICATION <br /> All information must be submitted in full before plan review will be started. <br /> (please print all information) <br /> ------------------------------------------------------------------------------ --------------------------- <br /> TI3E APPLICANT IS: (circle one) OWNER O CONTRACTOR <br /> JOB SITE ADDRESS: ���O �o�"Tl� �}2�] p2f(/� ZIp; <br /> �f �r�Mi� ISSo��✓J 11�f �S GU �/e ` /s �LaG,�� o�F���n T�JIS , <br /> Sf}�£ f�(�S£ �lp ��/.ChJa �l�SbP�E'`1 /'''�c�-i� /�1 f�a��ne �, c��x c�vnVe(� 5���� n�_u <br /> o r <br /> NAME OF OWNER: �/�(� ��-(�/_c>ti//� PHONE: (home) <br /> (work) <br /> MAILING ADDRESS: �90 h a�tlt f�/�1 d2• CITY: �l�/Y O ZIP: <br /> CONTRACTOR: C��Sn2u c�^( PHONE: �/7 y-807 � <br /> CONTACT PERSON: MOBILE/PAGER: 3o g-/�'7�/ <br /> MAILING ADDRESS:��'6�S O� FXG, �3��b. CITY: �xG. ZIP: SS33/ <br /> STATE LICENSE: # //(�o <br /> ARCHITECT/ENGINEER: j�S I�neY�,— �Pi��GO(/.��Z. PHONE: c�G�/�i <br /> MAILING ADDRESS: CITY: ZIP: <br /> NAME; REGISTRATION# <br /> TYPE OF WORK: New Addition Accessory Structure <br /> Move Remodel/Alteration� Land Alteration <br /> PROPOSED WORK(describe in detain: d 2 .�xIS77Nla �"�-��T l2� <br /> 1�, S �t, l r �/s / o a�z i hs�'lufc - /�� Gtks �Sr D� <br /> STORIES: �1A7� 15 C SQ.FEET OF EACH FLOOR: /3D7 � <br /> NO. OF BEDROOMS: � GARAGE STALLS: ATT. DET. <br /> ESTIMATED CONSTRUCTION VALUATION(excluding land): $ �j D 0� <br /> I hereby apply for a building permit and I acknowledge that the information above is complete and <br /> accurate; that the work will be in conforniance with the ordinances and codes of the City and with <br /> the State Building Code; that I understand this is not a pemut and work is not to start without a <br /> permit; and that the work will be in accordance with the approved plan. <br /> APPLICANT'S SIGNATURE: � �%U DATE: I� 9� <br /> NOTE! Parade Qf Homes events require separate permit approvaZ by Police Department and <br /> City Council 60 days prior to the event. Non permitted events will not be allowed. <br /> 6 <br />