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� • ~• <br /> I / 3 � , � <br /> Total Fee: $ �� �'7 � Date Received: / —�L1 —C/� <br /> Entered By: �-���/l/1� / Perm.it#: � (��C� � <br /> ��j � y - <br /> CITY OF OR��- BITII�DPIG PERi1�IIT APPLICATION <br /> All information must be submitted in full before plan review will be started. <br /> (please prirct all information) <br /> 'I'I� APPLICANT IS: (circle one) OWNER OR CONTRACTOR <br /> / — <br /> JOB SITE ADDRESS: �9�0 S� � re !/i�D �� v'�ZIP: �J���f� <br /> NAl�IE OF OWNER• �a ri� GGt s7�'����n PHO��tE: (home) L- -�,1�� <br /> (work) <br /> i�IAII.,�1G ADDRESS: CTTY: ZIP: <br /> C0�1'�RA.CTOR: � D PH0�1E: p �j -- � -�?,�I <br /> COr�TACT PERSON: ` I1�iOBILE/PAGER l�-- %� - <br /> I�IAILI�i 1G ADDRESS: ✓ CTI'Y: ��-y2��/�(p <br /> STATE LICENSE: ����;��.�f� <br /> ARCHITECT/ENGliYEER: P���� <br /> I�IAII�ING ADDRESS: CITY: ZIP: <br /> N�y�: REGISTRATION# <br /> TYPE OF `VORK: New Addition Accessory Structure <br /> Move Remodel/Alteration X Land Alteration <br /> PROPOSED WORK(describe in detai�: F� � O�'''V <br /> L ✓ -r <br /> ,�ol��� <br /> STORIES: a- SQ.FEET OF EACH FLOOR: <br /> NO. OF BEDROO�IS: GARAGE STALLS: ATT. DET. <br /> ESTiI�i IAT'ED CONSTRUCTION VALUATION (eXCludin;lanc�: $ ��! �4a <br /> I hereby aoply for a buildin'permit and I ac�owled�e that the information above is complete and <br /> accurate; �Iiat the work will be in conformance with the ordinances a.nd codes of the City a.nd with <br /> � the State Buildin� Code; that I understand this is not a permit and work is not to start without a <br /> pers�'� ��d that the work will be in accordance with the approved plan. <br /> APPL�CANT'S SIGNATURE: DATE: �'� �-�T�-� <br /> 1�'OTE! P�rade 4f Homes events require separate permit approval by Poliee Depariment and <br /> City Council 60 days prior to the event. Non permitted events will not be allowed. <br />