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Oct 10 2006 9: 29RM HP LASERJET FRX 612-825- 1900 p. 5 <br /> ,_ <br /> `��i' i <br /> I`�• � <br /> ! + � I `\ � �,4, <br /> ,i 1 <br /> Total Fee: � ��I� 7� Date Received: � � " I D- C�,6 <br /> Entered By: Permit#�: /�..I O�3 7 <br /> CITY OF OR NO - SUILDING PERMIT APPLICATION <br /> All information mus be submitted in full before plan review will be started. <br /> (please print all informatian) <br /> THE APPLICANT IS: circ[e o�e) OWNER O CONTRACTOR <br /> JOB SITE ADDRESS: �� S r ZIP: SJr 3 q� <br /> Will this be a Parade of Ho es, Remodelers Showcase Home or other Display Home? <br /> ❑ Yes ❑ No If yes, a sp cial event permit is req�ired with Police Department and City Council approval <br /> 60 days prror ro the event. Shuttle bus service wil!be required unless applicant demonslrates <br /> su�cient site parking is available. Non permitted everrts wil(not be allowed <br /> NAME OF OWNER: i abr � PHONE: (home) �52-`f71- `��f3�} <br /> (work) <br /> MAILING ADDRESS: 5 S�lore�in� Dr. CITY: fiD� ZIP: 5 ��( <br /> CONTRACTOR: � r � e�i PHONE: !�l Z-SZS �33 S 3 <br /> CONTACT PER,�ON: � � ` BILE/PAGER: �oI2�<�}-.�,�,3�� <br /> MAILINGADDRESS: '�o ef U� . CITY: S ZIP: SS <br /> STATE LICENSE: # 33 EXPIRATI4n'DATE: 3�3 t/07 <br /> ARCHITECT/ENGINEER: PHONE: <br /> MAILING ADDRESS: CI'I'y; Zip; <br /> NAME: REGISTRATION: # <br /> TYPE OF WORK: New Ho e Additian Accessory Structure <br /> Move H me RemodeUAlteration (ie: Siding, Windows) <br /> Any ea th movement may require MCWD review an permits ! <br /> PROPOSEDWORK(describ ir�detai�: _ ej'17oV� a R�ola�p [�c� <br /> STORIES: Q.FEET OF EACH FLOOR: <br /> NO. UF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED <br /> ESTIMATED CONSTRUCT ON VALUATION(exduding land): $ 3��7Q� .� G <br /> I hereby apply for a building perm t and I acknowledge that the informatian above is complete and accurate; <br /> that the work will be in conforrn ce with the ordinances and codes of the City and with the State Building <br /> Code;that I understand this is not perrnit and work is not to start without a permit;and that the work will be <br /> in accordance with the approved lan. <br /> APPLICANT'S SIGNAT DATE: �O I U b <br /> 31 <br />