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Total Fee: 42.2-_53. Date Received: RD i35°1 <br /> Entered By:_ `-4 / 6/(0 Permit#: '11 <br /> IT OF ()RUING - J CJILDING 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 OR CONTRACTOR <br /> JOB SITE ADDRESS: 20 C.\a O ce_karc1 1A ZIP: 553// <br /> Will this be a Para of Homes, Remodelers Showcase Home or other Display Home? <br /> ❑ Yes I kr No If yes, a special event permit is required with Police Department and City <br /> Council approval 60 days prior to the event. Non permitted events will not <br /> '-7— be allowed. <br /> NAME OF OWNER: T I Yh Vtur ky PHONE: (homeS-2.)1(76- age/ <br /> (x'Cr‘a (work) <br /> MAILING ADDRESS: 20 b O rGh ar d Fd CITY: O rorl o ZIP: 553`1( <br /> CONTRACTOR: ] e j sS1 c 'tv i(ciers RCat ode(er'S PHON 2 q ( ' L(4 <br /> CONTACT PERSON: [' k E'e_c,vt v� MOBILE/PAGER 1 226- ZZ`� <br /> MAILING ADDRESS: 2 q1 ? 1, CITY:S . • c _ ZIP: 553P <br /> STATE LICENSE: # Zao(564, <br /> ARCHJT.ECT/ENGINEER: C. ce c v Act-i`v\ PHONEC; ` c-111 -9 qgq <br /> MAILING ADDRESS: '$ 4 t-t CITY: ZIP: <br /> NAME: REGISTRATION# <br /> TYPE OF WORK: New Accessory Structure ✓ <br /> Addition Move <br /> tf45J pk� - \e Remodel/Alteration Land Alteration <br /> \ . , ( )o )(o' Z�,l <br /> "PROPOSED WORK(describe in detail): Tern.,v� exZe�,�n `� C t vS S�c� ,r.c( <br /> 04) °t1 r c.)c Sccc 00--.04_1 <br /> STORIES: SQ. FEET OF EACH FLOOR: <br /> NO. OF BEDROO S: GARAGE STALLS: ATT. DET. <br /> ESTIMATED CONSTRUCTION VALUATION (excluding land): $ /Si E7bO1. (DO <br /> I hereby apply for a building permit and I acknowledge that the information above is complete and accurate;that the <br /> work will be in conformance with the 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 that the work will be in accordance with <br /> the approved plan. <br /> APPLICANT'S SIGNAT `A _� DATE: 76- <br />