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CITY OF ORR/O�NO - BUILDING PERMIT APPLICATION <br /> Total Fee: $ a ��„b Date Received: q� <br /> f\ Date Approved: <br /> Entered By: 1 ' <br /> 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 o NTRACTO <br /> JOB SITE ADDRESS: �.��1��,� _ ZIP: <br /> (work) L <br /> NAME OF OWNER: <br /> •yyt,c; � �i D ..,. PHONE: (home) 12 3 -L a b <br /> MAILING ADD]!�ESS Q� ,�n�Q� �.o CITY: ZIP: <br /> CONTRACTOR: � � �iG PHONE: <br /> MAILING ADDRESS: /S'y(o 7Z._z,0a0A CITY: ZIP: ST3 9 <br /> TYPE OF WORK: New Addition Accessory Structure Move <br /> Demo Rem�r/Alteration_ Renovate Land Alteration <br /> PROPOSED WORK (describe in detail) : moi- 04rg:,& <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 /> e-1-' <br /> APPLICANT'S SIGNATURE: DATE: <br />