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CITY OF ORU !O - BUILDING PERMIT APPLICATION <br /> Total Fee: $ /550 Date Received: <br /> Date Approved: <br /> Entered By: J2A1 u, <br /> Permit#: .ice <br /> ALL INFORMATION MUST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED <br /> (See Check-off List Enclosed) <br /> THE APPLICANT IS: (circle one) 6NER)r CONTRACTOR <br /> JOB SITE ADDRESS: ///5 (--,-/67//oL,0 Z)r ,S-6 ,-(7-11 ZIP: SS 3`7 <br /> (work) 587- 35-73 <br /> NAME OF OWNER: 0/I G� h r i r /So^/ PHONE: (home) y 7x Z <br /> / <br /> MAILING ADDRESS: /1-AL✓ CITY: O ao/J o ZIP: SS 3 <br /> CONTRACTOR: 1.0 S PHONE: <br /> MAILING ADDRESS: CITY: ZIP: <br /> STATE LICENSE: # <br /> ARCHITECT/ENGINEER: PHONE: <br /> MAILING ADDRESS: CITY: ZIP: <br /> NAME: REGISTRATION # <br /> TYPE OF WORK: New Addition Accessory Structure > Move 'C <br /> Demo Remodel/Alteration Renovate Land Alteration <br /> PROPOSED WORK (describe in detail) : /o CA Tc /0 X /0 / f�C c �.5Sb y 5 C <br /> LL4..id (g/1,r4C ,ec�C11 0 o Nr .4a-g- L, <br /> S / <br /> STORIES: SQ. FEET OF EACH FLOOR: 700 <br /> NO. OF BEDROOMS: ,- GARAGE STALLS: ATT. DET. <br /> �U <br /> ESTIMATED CONSTRUCTION VALUATION (excluding land) : $ ZOO <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 <br /> the approved plan. <br /> APPLICANT'S SIGNATURE:/� <br /> ems% DATE: &//z/41.3 <br /> o �� Or7-q3 <br />