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� , <br /> _ . / � �� �:'� <br /> Total Fee: $ Date Received: - �' �-�(�, ��� <br /> Entered By: � Permit#: <br /> / ` j'y)cl- �1�J��� <br /> � �ITY 6F ORONO - BUILDING PERMIT APPLICATION <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 OR CONTRACTOR <br /> ,� <br /> JOB SI'TE A.DDRESS: ��'I�.� �• ��j,�7/�� „f�!'•� ZIP: � <br /> . � <br /> N��LE OF OWNER: G— �� 1� /l���PHONE: (home) ( � �` �J <br /> . (work) <br /> NIAII,ING ADDRESS: CITY: Zg': <br /> CO\?TRACTOR: �C��`��' C'>C�L�Ii,�C: �'� PHONE:. <br /> COr�T'ACT PERSON: MOBTI.E/PAGER: <br /> 1VLAaZING ADDRESS: CITY: Z�: <br /> ST�TE LICENSE: # <br /> ARCHTTECT/ENGINEER: PHOi�tE: <br /> NI_�II,Pi 1G ADDRESS: � CITY: Z�: <br /> �Tey��: REGISTRATION# <br /> TYPE OF WORK: New Addition Accessory Structure <br /> Move Remodel/Alteration Land Alteration <br /> PROPOSED WORK(describe in detain: I� �"C � � S �`�i1�-5 <br /> , t� �-� <br /> . <br /> STORIES: SQ.FEET OF EACH FLOOR: <br /> NO. OF BEDROOviS: GARAGE STALLS: ATT. DET. <br /> /'J �� <br /> ESTLI-IATED CONSTRUCTION VALUATION (excluding land): $ `�i��d�. �� <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 Buildin� Code; that I understand this is not a permit and work is not to start without a <br /> perm.it; and that the work wilI be i corda � 'th the proved plan. <br /> � � <br /> APPLICANT'S SIGNATURE: L ��' DATE: �G� G� � �� <br /> NOTE! Parade of Homes events quire separate permit approval by Police Department and <br /> City Council 60 days prior to the event. Non permitted events will not be allowed. <br /> 5 <br />