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w <br /> CITY OF ORCNO - BUILDING PERMIT APPLICATION <br /> ;tal Fee: $ X51117 Date Received: <br /> Date Approved: <br /> zered By: f✓ - Permit r: <br /> �L INFORMATION MUST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED <br /> (See Check-off List Enclosed) <br /> -------------------- <br /> y APPLICANT IS: (circle one//) O;VNER or CONTRACTOR <br /> ;B SITE ADDRESS: 3025 yYrJ�[�PY'PiS�'� z®/I,, LfI5�7 ZIP: �✓`��"� <br /> (work) �- <br /> �p <br /> AME OF OWNER:�OJ;4,0rL rlrJl� l�s'C»/'�r �c ��r� PHONE: (home) <br /> AILING ADDRESS�i �4rC��'14Y�n O"� CITY:��� �� �` ZIP: �> <br /> PHONE: <br /> NTRACTOR: cdJ' G / L° P� <br /> S �Aa <br /> LING ADDRESS: 2922 ✓ pww k ne-tiee CITY: tee- 2-a ZIP: <br /> y'ATE LICENSE: z <br /> ICHITECT/ENGINEER: PHONE: <br /> ,.ILING ADDRESS: <br /> CITY: ZIP: <br /> ,ME_ REGISTRATION u <br /> 'PE OF WORK: New Addition Accessory Structure Move <br /> Demo Remodel/Alteration Renovate/ Land Alteration <br /> OPOSED WORK (describe in detail) :_ <br /> 'ORIES: SQ. FEET OF EACH FLOOR: <br /> *7_ OF BEDROOMS: GARAGE STALLS: ATT. DET. <br /> ,. TIMATED CONSTRUCTION VALUATION (excluding land) : <br /> hereby apply for a building permit and I acknowledge that the information <br /> ove is complete and accurate; that the work will be in conformance with the <br /> -dinances and codes of the City and with the Sate Building Code; that T_ <br /> derstand this is not a permit and work is not to start without a permit; and <br /> ;at the work will be in accordance with the approved plan. <br /> ' S I GNATORE: ti <br /> DATE: <br /> _>PLICANT S <br />