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CITY OF QRONO - BUILDING PERMIT APPLICATION <br /> Total Fee: $ Lo5a + o " Date Received: <br /> Date Approved: 513b/9) <br /> Entered By: , <br /> Permit#: -3711 <br /> ALL INFORMATION MUST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED <br /> (Sed Check-off List Enclosed) <br /> THE APPLICANT IS: (circle one) OWNER or ‘ONTRACTO <br /> JOB SITE ADDRESS: 335 Old C415< ZIP: 5535(0 <br /> 00-V41° (work) 4-76-53C9 <br /> NAME OF OWNER: I a) 1 PHONE: (home) 4%-095-) <br /> MAILING ADDRESS: 0015 CTL `JSide, CITY: L,CrAi L) ZIP: 5535( <br /> CONTRACTOR: (Y G ea- j PHONE: 4-73-(al24- <br /> MAILING ADDRESS: P. O. Bpc CITY: (A t s.a..0- ZIP: 5535cp <br /> TYPE OF WORK: New Addition Accessory Structure Move <br /> Demo Remo�c�/Altelration K Renovate Land Alteration <br /> PROPOSED WORK (describe in detail) : t _4 addition lz) eK Sthr ) ► o n- <br /> STORIES: 1 SQ. FEET OF! EACH FLOOR: 15Ra <br /> NO. OF BEDROOMS: 3 GARAGE STALLS: ATT. DET. D-C, <br /> ESTIMATED CONSTRUCTION VALUATION (excluding land) : $ 4-5,QaX <br /> I hereby apply for a building permit and I acknowledge that the information <br /> above is complete and accurate; that the work will be in conformance with the <br /> ordinances and codes of the City and with the State Building Code; that I <br /> understand this is not a permit and work is not to start without a permit; and <br /> that the work will be in accordance with the approved plan. <br /> APPLICANT'S SIGNATURE: DATE: 'D•3 <br />