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Total Fee: Date Received: 3 <br /> Entered By: c _. Permit #: <br /> 60 to 39`7 <br /> CITY OF OR NO - BUILDING PERMIT APPLICATION <br /> All information must be submitted in full before plan review will be started. <br /> (please print all information) <br /> ---------------------------------------------------------------------------------------------------------------------- <br /> THE APPLICANT IS: (circle one) OWNER R CONTRACTOR <br /> JOB SITE ADDRESS: 34 b-TUR.NIAVkNk QOND ZIP: S53 ,55 <br /> NAME OF OWNER: k-0 L-AIM0 JUR6ENS PHONE: (home) q5Z-473 -5307 <br /> (work) 7(03- S25- 670.3 <br /> MAILING ADDRESS: 3�0 Tv2NH,4M R60W CITY: 04d,-,Q9 ZIP: 553 <br /> CONTRACTOR: CD W tAf-z PHONE: 75-Z - 473 -V,307 <br /> CONTACT PERSON: ,Qoe-4nl,D -_-5' MOBILE/PAGER: (/Z - 76.3 - 9/0 <br /> MAILING ADDRESS: - ?uetyWArA,&,4,0 CITY: 0120N0 ZIP: Ssg <br /> STATE LICENSE: # nVz <br /> ARCHITECT/ENGINEER: AIOIV2�- PHONE: <br /> MAILING ADDRESS: CITY: ZIP: <br /> NAME: REGISTRATION # <br /> TYPE OF WORK: New X Addition Accessory Structure <br /> Move Remodel/Alteration Land Alteration <br /> PROPOSED WORK (describe in detai): /2" X /(o '' fi4dT F-Z --T-,EA <br /> Yoram-jRgQr. <br /> STORIES: / SQ. FEET OF EACH FLOOR: SQ r1c:T <br /> NO. OF BEDROOMS: O GARAGE STALLS: ATT. 0 DET. O <br /> ESTIMATED CONSTRUCTION VALUATION (excluding land): $ 1560 ,CO <br /> I hereby apply for a building permit and I acknowledge that the information above is complete and <br /> accurate; that the work will be in conformance with the ordinances and codes of the City and with the <br /> State Building Code; that I understand this is not a permit and work is not to start without a permit; <br /> and that the work will be in accordance with the proved plan. <br /> APPLICANT'S SIGNATURE �� - DATE: !2 ZoG3 <br /> NOTE. Parade of Homes events require separate permit approval by Police Department and City <br /> Council 60 days prior to the e vent. Non permitted e vents will not be alio wed. <br />