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CITY OF t�t�-- B�ZDING PERMIT APPLICATION <br /> � -� � • Date Received: <br /> Total Fee: $ �� . <br /> Date Approved: ' <br /> Entered By: � Permit Q: � �a 6 . _ . _ <br /> � t <br /> AT.T INgOgMATION MIIST BS SUBMITTED IN FULL BEFORE PLAN REVIEW WII,L BB- SgBRTF.D <br /> (See Check-off List Enclosed) <br /> ------------------- <br /> -------------- <br /> � �pZI�T Ig: (circle one) : i�TNE pr CONTR.ACTOR <br /> �y . ZIP: �S� � <br /> Jos si� AnDRsss: y 3 �o Yl o r-�1.. S �o � _ <br /> � (work) �7 Y- 3 Z-�c,� <br /> NAI� OF OWNEK: �..c�i I�;a T S LV�o e n � v►� PHONE: (home) Y 7�.—3'7 J`3 <br /> C 0 ra Y+�� <br /> ci�r:�� o c.c ���_____._ zzP: �� 3��I <br /> MAII�ING ADDRESS: �l 3�6 n , S h O rg IO �, _ � <br /> PHONE: <br /> CONTRAC'rOR: � <br /> MAILING ADDRESS: <br /> CITY: ZIP: <br /> STATE LICENSE: � <br /> PHONE: � <br /> ARCHSTECT/ENGINEER: "" <br /> ��q: Z IP: <br /> MAT_T ING ADDRESS: <br /> REGISTRATION s <br /> NAM�t <br /> Addition Accessory Structure Move__ <br /> TYPE OF WORR: New Renovate Land Alteration__ <br /> Demo Remodel/Alteration <br /> PROPOSED WORR (describe ia detail) : �'-- �° ` �' r � � <br /> � Q � � a <br /> STORIES: SQ. FEST OF EBC� FZOOR: <br /> NO- OF BEDROOMS: GAR.AGE ST1�LI�S: ATT. DET. <br /> ESTS�iTED CONSTRIICTIoN VALIIATION (eaclndi_ng land) : $ ���QU� <br /> I hereby apply for a buildinq permit and I ackncwledge that the information <br /> above is ccmplete and accurate; that the work will be in conformaace w thh �hi <br /> ordinaaces and codes of the City and with the State Building Code; <br /> understand this is not a pertuit and work is not to start withvut a pe�it; and <br /> that the wvrk will be ia accordance with the approved plaa- _ . - <br /> �,7 � �/ � �� DATE: . �l�/��9 �.�-- <br /> APPI.ICANT'S SIGNATURE:�V.��G�"'-� �• <br />