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• <br /> CITY OF ORCNO -BUILDING PERMIT APPLICATION <br /> Total Fee: $ Date Received: <br /> Date Act roved: <br /> BY: . <br /> Entered e Permit!t- '6 <br /> ALL INFORMATION MUST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED <br /> (See Check-off List Enclosed) <br /> 'HE APPLICANT IS: (circle one) OWNER o —7) <br /> OB SITE ADDRESS:c 5/ 3 20 . kZ`te 6 ZIP: c,'_5:6:36----6) <br /> (work) �/ <br /> _;AME OF OWNER: <br /> /. SLG &A. r PHONE: (home) I`"/7 3 J 76,V <br /> MAILING ADDRESS: 6' CITY: ZIP: <br /> ?� C'hLCCLA- /1464./44c, PHONE J:5 6C) ,- U <br /> �DNTRACTCR: // / I' ` �� ,�L/� <br />.AA.ILING ADDRESS ///0C /- Y'= Z �tllt ZIP: <br /> ;TATE LICENSE: # 066 c Z MN CONTRACTORS <br /> UC. 12406 <br /> ' RCHITECT/ENGINEER: PHONE: <br /> AILING ADDRESS: CITY: ZIP: <br /> AME_ REGISTRATION # <br /> VPE OF WORK: New Addition .„..--- Accessory Structure Move <br /> Demo Remodel/Alteration Renovate Land Alteration <br /> WORK (describe in detail) : K (Li <br /> �x.cii) 0o-v-6..,c_ <br /> rROPOSED 1 <br /> 1011.10 I Oil Cit---OC <br /> TORIES: SQ. FEET OF EACH FLOOR: <br />'±O. OF BEDROOMS: GARAGE STALLS: ATT. DET. <br /> ESTIMATE') CONSTRUCTION VALUATION (excluding land) : $ 71 ` ' CJ O <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 /> rdinances and codes of the City and with the State Building Code; that I <br /> derstand this is not a permit and work is not to start without a permit; and <br /> :iat the work will be in accordance with the approved plan. <br /> 9. <br /> • <br /> ---- eit_. 4 DATE: c' " <br /> �?PLIC�NT S SIGNATURE_ <br />