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•� CITY OFv OROIv'O - BUILDING PERMIT APPLICATION <br /> Total Fee: $ / 11• t°-< Date Received: (0179j <br /> Date Approved: <br /> Entered By: ,&V <br /> Permit#: c 7o <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) COWNE.F or CONTRACTOR <br /> JOB SITE ADDRESS: 1I C5 kb1,3 Ki, g. ZIP: . s �csi 1 <br /> (work) -S0$ <br /> NAME OF OWNER: A'Zsk-t "7---E.,(. 11/•\:"E.:172_ PHONE: (home) L0 - ( l`i G <br /> MAILING ADDRESS: --1..Atx.J, �4 CITY: L',Pu'ZA7y. ZIP: '�S�ci 1 <br /> CONTRACTOR: 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 <br /> Demo Remodel/Alteration Renovate Land Alteration K. <br /> PROPOSED WORK (describe in detail) : 5 e. ci C -2-Atc f C.-1Z":2-A---,T WO <br /> -1k-Cr-- -.e; _i"b, 'a Q a c Q ZV.J• lZ L l w 12 Q 1 cl��i -k. c <br /> STORIES: I SQ. FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. <br /> ESTIMATED CONSTRUCTION VALUATION (excluding land) : $ O CICw <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 /> APPLICANT'S SIGNATURE:-- <br /> ( DATE: V ` LCR ` Z <br />