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I't- 4A LT :'Ve/W <br /> Toil $ _ Date Received: <br /> Entered By: Permit#: <br /> CITE' OF O O O m BUILD G "MUT APPUCATION <br /> AN Information must be submitted in full Aefore plan re'view will be started, <br /> (please Prim all informarlon) <br /> -----------------4Y----�___-----------------______-- <br /> THE APPLICANT IS: (circle one) OWNER 0 ®NTRACT®R <br /> JOB SITE ADDRESS: ac-23b O l d ZIP; '2 J <br /> NAS OF OWNEIL <br /> q�}� �,T�1g�g,��i (work) <br /> CONTRACTOR; Arcc ct �PHONE: <br /> �CgO®l'��g'�A `TSP PERSON: Mao <br /> (� � j� � OBILE/PAGER: <br /> �V�615ARJ.d�G DRESS., { ao cougA-4 ��L1 C <br /> S` ATF, LICENSE: #.a1 a 98a <br /> A,RC T CT/RNGINEER: PHONE: <br /> MAILING ADDRESS. Com: ZIP: <br /> N IE° REGISTRATION# <br /> TYPE OF 'CORK: New Addiaion Acctssory Structure <br /> Move Remodel/Alteratson ted Alteration <br /> PROPOSED WORK(describe in detail)�� t ��� oc, <br /> STORIES.- SQ.FEET OF EACH F'I,O R*- <br /> NO. OF BEDROOMS: GAGE STALLS: ATT. DET. <br /> TEWATED CONSTRUCTION VALUATION (excRuding laxed): $ �,qS 4007, <br /> I bpxeby apply for a building pormit and I acknowledge that the information above is comptlete wid <br /> wcurate; that ffic work will be in conformance with the ordinances and lades of the City and with <br /> the State Building Code; that I understand this is not a permit and work is not to start without a <br /> permit; and that the work will be in accordame with the approved Calan. <br /> APPLICANT'S SIGNATURE: Ci►'L1 DA'T : <br /> NOTE! de Uf a eveafs require sipamte permit pproval by police Dela ent and <br /> CRY Council 40 44y3 prior to the event, dant penaltted eveswPs will,lot De allowed. <br /> t!C!( a i ❑e,� Ti h,,, C,.., �A 1 ,1�n1,R D., _ 1 m:___ r _ _ n 4 a n513r - <br />