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iIL' <br /> Total Fee: $ 46- (5Zo Date Received: <br /> Entered By: ILA!, Permit#: 1 Q 10-7) <br /> CITY 0 F ORONO - BUILDING PERMIT APPLICATION <br /> All inform.tion 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 /> UE <br /> JOB SITE ADDRESS: b-56 0 ,57, <br /> NAME OF OWNER: < 1 HA(Y%Z PHONE: (home) <br /> �t�4� (wor ) <br /> MAILING ADDRESS: 1556 °DP° ( CITY: ZIP: ,5.-- 5--)„. <br /> CONTRACTOR: 4L I N C is � \L1/r PHONE: fp - r tj <br /> CONTACT PERSON: MO: I E/PAGER: A A tir� M. <br /> ' <br /> MAILING ADDRESS:tk 'f i•I !: ITY: exp� ZIP: <br /> STATE LICENSE: # � o V WY '�K <br /> ARCHITECT/ENGINEER: PHONE: <br /> MAILING ADDRESS: CITY: ZIP: <br /> NAME: REGISTRATION# <br /> TYPE OF WORK: New Addition Accessory Structure <br /> Move Remodel/Alteration X Land Alteration <br /> PROPOSED WORK(describe in detail): ` I'll _ r0 r 0 ► <br /> I i rii-T-44 • . 'BAC • ' A / <br /> STORIES: SQ.FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS: . GARAGE STALLS: ATT. DET. <br /> ESTIMATED CONTRUCTION VALUATION (excluding land): $ 420/ CO 0 <br /> I hereby apply for a ilding permit and I acknowledge that the information above is complete and <br /> accurate; that the wo will be in conformance with the ordinances and codes of the City and with <br /> the State Building C e; that I understand this is not a permit and work is not to start without a <br /> permit; and that the ork will be in accordance with the approved plan. <br /> APPLICANT'S SI 1 ATURE: i 4P°: .!,L. i _ <br /> 4DATE: f 1 - 2,- '1 1 <br /> NOTE! Pc ru - , s: s ii ' events require separate permit approval by Police Department and <br /> City Council 60 days prior to the event. Non permitted events will not be allowed. <br /> 5 <br />