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Total l+ee: $_�3�j7�� Date Received: � /,3/,��_ <br /> Entered By: Permit#: � � � <br /> CITY OF OROl`�O - 13UyLI)1NG PERMIT APPLICATION <br /> All information must be submitted in full before plan review will be started. <br /> (��lease prir�t tell inf�ri�►afiort) <br /> ------------------------------------------------------------------------------------------------------------�------------- <br /> �'HE APPLICANT IS: (c�rrcle oian) 0�'V1�1ER OR CONTIZACTOR <br /> JOB SITE ADDRESS: ��������.��-_��� ZIP: �����Q <br /> �Vill this be a Parac�e of]Home�, I�em�delers �ho��vcase �Iome or other Display Ho:me? <br /> ❑ Yes ❑ No If yes, a special everzt perniit is required with Police Deparhuent m��l Ciry Coiuzcil approva! <br /> 60 d«,>>s prior to t/�e evei�t. Shuttle fiirs se�vice tivill be req��ired unless applicant rlemonstrates <br /> sufficie�it ojt-site pm-l�rng is uvailnblc�. No��-per�rritted eversls it�i!/raot be allo�v��d. � <br /> � � <br /> NAM�OF O�'4�NE�2: � _ �'Y3�1�TE: (home)--�� <br /> rL/�S , (�vark� '�-� `7'�� _pp 3� <br /> ����IL�Nc�DD��ss: P �����: zlp: _�� <br /> CyONTRACTOR. �__��f �L.�_ PlIONY�. <br /> -��� �+ __ <br /> co�vTa�c�r I��risc�N: �►��•��.,�.� ��c��ILri��cER: �`�j������ <br /> MAILING ADI�RL,SS: �,,,ti CIT�': 7Ip: <br /> STATE LIC�NSL: #�,��, (���.�-- - E�:PI�:ATION I)ATI::� 1��_ <br /> T <br /> �r�cxlT�cT�r�.rr�INr��rz: ���c. � c,� oN�;: ���,���� <br /> n�tAILING�DD��SS: -5�����"-�.'��4-��c-�-C'I��"Y: 7I]P: �r,� r-z <br /> NAIVIE: --�.C�,�'-t�C_---�� — 12�GI5`TI:A ON: # _�;-<�. p � C3�1a0�'w�, <br /> "TYP� O1� �VORK: Ne�v _�._ Adciil:ion _ Accessory Stnicture <br /> Move Home Remodel/Alteration <br /> �'1201'OSE�W�R�(desc�•ibe iri detrrr�:-��' �— �1.�� /' ) -� �e�..� � /e.c��,� ��. <br /> � r n <br /> �h,��c�E�: � �w`�' �.���;�',�'�r���,���`������o�: 4�' - 7 �v <br /> ��1�. _ � � <br /> �v�. �r����oo���s: � r��A��� ����,�,�: ������������ � �ra��x��_ <br /> ES'I'IlVIf4.T�D ��1�tS7'�2IJ�`���I�I�J�I�IJr��,�OI'd(e�cl�at3ir�;lan�): � 5 ��_ <br /> I hereby apply for a building pernlit and 1�ackno�vledge that the infornlatio >ove is coillplete and acctirate; <br /> tliat the work will be in conformance with t(Ze ordulances aud codes of � e City aild with the SCate Buildin� <br /> Code; that I understand tliis is not a�-�ern�it ai w k i� ot star[�v' out a permit; and that the tivork will be <br /> in accordance with the approved pl�n. � <br /> APPLICANT'S SICaiVATURE: ��1�; ' <br /> 3t <br />