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� , � <br /> Total Fee: $ i Cv Z �'� Date Received: �����' j �G^�' <br /> Entered By: � - Permit#: ; � , ,%•�,- <br /> � <br /> CITY OF OR�N�- BUILDING PERMIT APPLICATION <br /> All information must be submitted in full before plan review will be started. <br /> (please p�•int all infoi�rnation) <br /> ---------------------------------------------____�___�___--_-------------- <br /> THE APPLICANT IS: (circle one) OWN R R CONTRACTOR <br /> �--,,,, <br /> JOB SITE ADDRESS: ��S l�' �, �V��v t''���,������-� �, C��� ���'�-% ZIP• � � >j G <br /> Will this be a P ade of Homes, Remodelers Showcase Home or other Display Home? <br /> ❑ Yes �NO Ifyes, a special event pe»nit is reqirired with Police Department and City Coc�ncil approva/ <br /> 60 da��s p�-ior to the event. Shuttle birs se�vice wil/be required tulless applicant demonstrates <br /> st ffcient on-siteparlcing is available. Non pernzitted events wil/not be allowed. <br /> NAME OF OWNER: � h��wr1 � f�v�v� �Vv����(�iC�c'�" PHONE• (home)��5���/3� �2�1`�� <br /> (work)�5�-_�3 7-t�;�( <br /> MAILING ADDRESS: >�i� S;1�.� ���r��(��.� ��-. � CITY: �;v�1� ZIP: 3 Ss�G <br /> CONTRACTOR: ��� PHONE: <br /> CONTACT PERSON: MOBILE/PAGER: <br /> MAI�.ING ADDR.ESS: CITY: ZIp; <br /> STATE LICENSE: # EXPIRATION DATE: <br /> ARCIiITECT/ENGINEER: PHONE: <br /> MAILING ADDRESS: CITY: ZIP: <br /> NAME: REGISTRATION: # <br /> TYPE OF WORK: New Addition Accessory Structure <br /> Move Home Remodel/Alteration t� <br /> PROPOSEDWORK(describein detai�: � ��v�;;� h�������,�� -� ,�,�,�,�k4 . 5�,��=f,��/�, �/�-�-�,�,�„1s <br /> � (��t�tir"iii�lM. �H�a-f C�UtfS A�h'ac�y iH y,n�a(C.� <br /> STORIES: v2 ��s �'"�`�`Y't�SQ.FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS: � GA�ZAGE STALLS: ATTACHED DETACHED <br /> �in:l�iiir��?�.z c:ti. h�,tiy .,r��ir�/ �� hs•f�r,-���> - <br /> _ ->_, <br /> ESTIMATED CONSTRUCTION VALUATION(excluding land): $ � ��-�L� �� <br /> I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; <br /> that the work will be in conformance with the ordinances and codes of the City and with the State Building <br /> Code;that I understand this is not a permit and work is not to start without a permit;and that the work will be <br /> in accordance with the approved plan. <br /> �? j�,- <br /> APPLICANT'S SIGNATURE: f��"/�- �- " � - DATE: � ���i�� <br /> 31 <br />