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. . . �� n <br /> �e a.�, <br /> ,`,p� <br /> � <br /> Total Fee: $ �2�6, � Date Received: I I � <br /> Entered By: Permit#: Z <br /> CITY OF OR NO - BUILDING PERMIT APPLICATION <br /> All information must be submitted in full before plan review witl be started. <br /> (please print all irtforrriation) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR <br /> � ,� <br /> JOB SITE ADDRESS: � =' �v I�Ci ���-"� r��' �� ZIp; S� �� � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? <br /> ❑ YeS ❑ No If yes, a special event permit is required with Police Department and Citv Council approval <br /> 60 days prior to the event. Shutt/e bus service wil/be required unless applicant demonstrates <br /> suff cient on-site parking is available. Non- ermitted events will not be allowed. <br /> NAME OF OWNER: �►� G� ��/� � � PHONE: (home) <br /> It ,� � � r (work) <br /> MAILING ADDRESS: � � 7� ��'n 1(/�W' ,G�✓�1�'Y/�ITY: � �`� ZIP: �3 cc I <br /> CONTRACTOR: N��v+^� ����� I� ��"�oO�I�` - PHONE: �ZS Z��? ,� ���U <br /> CONTACT PERSON: �c�w, !3 c,,� h e �—,� MOBIL /PAGER: �o/2- 9/�! Z�D I <br /> MAILING ADDRESS:Sz 7S �P���pK !-�c�o /' �,{ CITY:1�'�� ,�-- ���, :,, ZIP: 5;5-3 S�( <br /> STATE LICENSE: # 2_vc� 2a o �� EXPIRATION DATE:�'3 �f v�— <br /> ARCHITECT/ENGINEER: PHONE: <br /> MAILING ADDRESS: CITY: ZIP: <br /> NAME: REGISTRATION: # <br /> TYPE OF WORK: New Home Addition Accessory Structure <br /> Move Home Remodel/Alteration (ie: Siding, Windows) <br /> Any earth movement may require MCWD r view and permits ! <br /> PROPOSED WORK(describe in detai�: !�e L� �Q�v� �� <br /> STORIES: SQ.FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED <br /> ESTIMATED CONSTRUCTION VALUATION(excluding tand): $��� � <br /> I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; <br /> that the work will be in conformance with the ordinances and codes ofthe City and with the State Building <br /> Code;that I understand this is not a permit and work is not to start without a permit;and that the work will be <br /> in accordance with the approved plan. <br /> APPLICANT'S SIGNATURE: DATE: ( � I � � <br /> 31 <br />