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CITY OF ORQtdn - BUILDING PERMIT APPLICATION <br /> Total Fee: $ Date Received: <br /> Date Approved: <br /> Entered By: Permit#: <br /> ALL INFORMATION MUST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED <br /> (See Check-off List Enclosed) <br /> ----------------------------- <br /> THE APPLICANT IS: (circle one) OWNER or CONTRACTOR <br /> JOB SITE ADDRESS: Y 7 FZIP: <br /> (work) <br /> NAME OF OWNER: �� �` , Lc<�� PHONE: (home) <br /> MAILING ADDRESS: i fi4 t< CITY: ZIP: <br /> �/}� E S <br /> CONTRACTOR:— /-' ��-� �'-'��5 0� �/ PHONE:`` <br /> MAILING ADDRESS: �' /`lc`ki4e s%�� CITY:_(=_�[�L L t-/7_ ZIP: 5rf Z <br /> STATE LICENSE: # C <br /> ARCHITECT/ENGINEER: PHONE: <br /> MAILING ADDRESS: CITY: ZIP: <br /> NAME: REGISTRATION # <br /> TYPE OF WORK: New Addition Accessory Structure <br /> Move <br /> Demo Remodel/Alteration _ Renovate Land Alteration <br /> PROPOSED WORK (describe in detail) <br /> STORIES: SQ. FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. <br /> ESTIMATED CONSTRUCTION VALUATION (excluding land) : <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 permit and work is not to start without a permit; and <br /> that the work will be in accordance with the approved plan. <br /> DATE: ` <br /> APPLICANT'S SIGNATURE: <br />