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� �y CITY OF OROZiO - BIIILDING PERMIT APPLICATIOI�i <br /> . <br /> Total Fee: $ Date Received: <br /> Date Approved: <br /> Entered By: Q <br /> Permit#: ��U�''` <br /> ALL INFORMATION MOST BE SOBIrIITTED IN FIILL BBFOR$ PLAN REVIEW WILL BE STARZ'ED <br /> -------------------------------------------------------------------------------- <br /> TH$ APPLICANT IS: (circle one) OWNER or CONTRACTOR <br /> � � <br /> JOB SITE ADDRESS: � ��/� STUf��S f��i� �� ZIP: <br /> (work) y7�'���- <br /> NA�: OF OWNER: (��r 7 /�✓'��� PHONE: (h ome) <br /> MAILING ADDRESS: S�q-ivt� CITY: La`'`,5 �� ZIP: <br /> CONTRACTOR: �(� �-I�����`�-✓ PHONE: �S7� -27 7/ <br /> MAILING ADDRESS: �,����G 3bg � CITY: MaN.�c.��(v ZIP: �'S36 'Z_- <br /> TYPB OF WORR: New Addition Accessory Structure Move <br /> Demo Remodel/Alteration Renovate Land Alteration <br /> PROPOSED WORR (describe in detail) : �P�y,o✓e d/✓ ��.�f_� D/��t <br /> STORIES:� SQ. FEET OF EACH FLOOR: �,3�`� <br /> NO. OF BSDROOMS: GARAG$ STALLS: ATT. DET. <br /> $STIMATSD CONSTRDCTION VALIIATION (excluding land) : $ a,�bad <br /> I hereby apply for a building permit and I acknowledge that the information <br /> above is complete and accurate; that the work will be in conformance with the <br /> ordinances and codes of the City and with the State Building Code; that I <br /> understand this is not a Fermit and work is not to start without a permit; and <br /> that the work will be in accordance with the approved p lan. <br /> APPLICANT'S SIGNATURE: • �p " �� <br /> �(,t��c( ��� DATE. � <br /> tPlease fill out the reverse side of this form) <br />