Laserfiche WebLink
Total Fee: $ a Date Received: /0- 5 -0 / <br /> Entered By: Permit#: <br /> /o/is <br /> CITY OF OR NO - BUILDING PERIVUT APPLICATION <br /> All information must be submitted in full before plan review will be started. <br /> (please print all information) <br /> THE APPLICANT IS: (circlt <br /> OWNER OR NTRACTOR <br /> v`�flM��� <br /> JOB SITE ADDRESS: ZIP: <br /> NA_�1E OF OWNER: Tif VEJ15 PHONE: (home)aS2 Q d <br /> r-1,� gn� � <br /> iViAILL1IG ADDRESS: r? ,1 CITY: �lJ ZIP: _ <br /> CONTRACTOR: 1 �k)LYHONE: <br /> CONTACTPERSMOBILE/PAGER: U– ; 2122 <br /> 1VLAMLNG ADDRESS: CITY: ��l ZIP: <br /> STATE LICENSE: <br /> ARCHITECT/ENGINEER• t bk) PHONE: <br /> M_A,ILJNG ADDRESS: CITY: ZIP: <br /> NAME: REGISTRATION# <br /> TYPE OF WORK: New Addition Accessory Structure <br /> Move Remodel/Alterati n Land Alteration <br /> PROPOSED WORK(describe in detail):q TY�T(�} (V)cuk 0A) <br /> u'021L —1-b 11\X LQ6 MEW 9e'!�zi&A <br /> STORIES: '2— SQ. FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. <br /> ESTMATED CONSTRUCTION VALUATION (excluding land): $, `2L, <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 <br /> the State Building Code; that I underbandd is not a permit and work is not to start without a <br /> permit; and that the work will be ince FAh th approved plan. <br /> APPLICANT'S SIGNATURE: DATE: k- 6 <br /> NOTE! Parade of Homes events require separate permit approval by Police Department and <br /> City Council 60 days prior to the event. Non permitted events will not be allowed. <br /> 5 <br />