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Y coot �k*p <br /> Total Fee: $ /88 , Date Received: -Or'p <br /> Entered By: Permit#: A694lo7 <br /> CITY OF ORONO - BUILDING PERMIT APPLICATION <br /> All information must be submitted in full before plan review will be started. <br /> (please print all information) <br /> THE APPLICANT IS: (circle one) OWNER O CONTRACTOR <br /> JOB SITE ADDRESS: 9 5*55 ©W ftPOA-0 ZIP: 5 5 3g ) <br /> Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home? <br /> ❑ Yes No If yes, a special event permit is required with Police Department and City Council approval <br /> 60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates <br /> sufficient on-site parking is available. Non permitted events will not be allowed. <br /> NAME OF OWNER: a-OM 14LlGlA LDOLTS PHONE: (home)'102,171- 7 559 <br /> (work) <br /> MAILING ADDRESS: 2535 QUQ 06P44--20'• CITY: 100 r 4; ZIP: <br /> CONTRACTOR: J644 0 TNS GjgLNAkg5 r JWL PHONE: X52• �p•'1999 <br /> CONTACTPERSON: 04' 44,I2 MOBILE/PAGER:`1572. 240• 143,-7 <br /> MAILING ADDRESS:(6l W ULV13. *219 CITY: WAq?A-ice. ZIP: S53G I <br /> STATE LICENSE: # A67,51 EXPIRATION DATE: 473 j D7 <br /> ARCHITECT/ENGINEER: Nj o r PHONE: <br /> MAILING ADDRESS: CITY: ZIP: <br /> NAME: REGISTRATION: # <br /> TYPE OF WORK: New Home Addition Accessory Structure <br /> Move Home Remodel/Alteration (ie: Siding, Windows) _ <br /> Any earth movement may require MCWD review and permits! <br /> PROPOSED WORK(describe in detail):JEE& 1;1 P§0L666 er%-yC1.o gQ&pyr, <br /> ML LaQ Pe4G ADD 65C pOQ.C•1 <br /> STORIES: 2• SQ.FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS: _ GARAGE STALLS: ATTACHED DETACHED_ <br /> ESTIMATED CONSTRUCTION VALUATION(excluding land): $ 1;% OCO <br /> I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; <br /> that the work will be in conformance with the ordinances and codes of the City and with the State Building <br /> Code;that I understand this is not a permit and wor ' not to start without a permit;and that the work will be <br /> in accordance with the approved plan. <br /> APPLICANT'S SIGNATU DATE: 0(O ' D? •O(p <br /> 31 <br />