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- 'Total Fee: $ Date Received: <br /> Entered i3y: Permit#: <br /> CITY OF (RONO - 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) CWI OR CONTRACTOR <br /> JOB SITE ADDRESS: (5 Oa CrY.Sta,` )O • ZIP: 5 5 35 :)y tom- <br /> NAME OF OWNER: _O 044 YA f(�,CV -(` PHONE: (home) 44916aq <br /> (work) 36,D.,-44 35 <br /> MAILING ADDRESS: : • ' Cr p c&t ' 4 ',, CITY: Li3n [_0X.Q-. ZIP: cc.356 <br /> CONTRACTOR: 5-ekf - PHONE: <br /> CONTACT PERSON: MOBILE/PAGER: <br /> MAILING ADDRESS: CITY: ZIP: <br /> STATE LICENSE: # <br /> ARCHITECT/ENGINEER: PHONE: <br /> MAILING ADDRESS: CITY: ZIP: <br /> NAME: REGISTRATION# <br /> TYPE OF WORK: Nev Addition Accessory Structure <br /> Move Remodel/Alteration )( Land Alteration <br /> PROPOSED WORK(de,;cribe in detail): ro p& kes r- o4 oa a ()co.) root <br /> STORIES: k`/2- SQ.FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS: 3 GARAGE STALLS: ATT. , DET. <br /> ESTIMATED CONSTR CTION VALUATION (excluding land): $ a,c8 az). OC) <br /> I hereby apply for a buil ' g permit and I acknowledge that the information above is complete and <br /> accurate; that the work ' 1 be in conformance with the ordinances and codes of the City and with <br /> the State',Building Code; at I understand this is not a permit and work is not to start without a <br /> permit; and that the wor will be in accordance with the approved plan. <br /> APPLICANT'S SIGNA ' : lowmstA DATE: 5 p-em,1 er (6 (492 <br /> - 1 <br /> NOTE! '!P.? ' i i i ' events require separate permit approval by Police Department and <br /> City Council 60 days p 4,r to the event. Non permitted events will not be allowed. <br />