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, <br /> Total Fee: $ {��� . Q / Date Received: ,���5��°� <br /> Entered By: Permit#: /� �� R% � <br /> �,y�,�/)ry � �(� <br /> CITY O OROl�O - BUILDING PERMIT APPLICATION <br /> All information must be submitted in full before plan review will be started. <br /> (please pri�zt all informr�tion) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> THE APPLICANT IS: (circle one) OWNER OR ONTRACTOR <br /> JOB SITE ADDRESS: 7�� ��0� �U I�d � ZIP: SS�3S G <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? <br /> ❑ Yes �NO If yes, a specia/event permit is r•eq�Fir•ed�virh Police Department arzd City Coairrcrl approval <br /> 60 davs prior to the event. Shuttle bars ser•vrce�vil!be��equired unless applicant demonstrales <br /> sa±�cient on-site parkrng is a>>nilable. Non-permitted eveiats�vil1 not be albtived. <br /> NAME OF OWNER: �►i� S c-� w� 1 2!E- PHONE: (home) <br /> (work) <br /> MAILING ADDRESS: � y y 13�0�--� (� n1 CITY: �I�AND9 ZIP: � <br /> CONTRACTOR:�E i2�e � S7�/Jb�i9 PHONE: �15Z - y7 y Z�`f o <br /> CONTACT PERSON: 1�'�2o'z MOBILE/PAGER: �I 2 • �6-S' 2 55�3 <br /> MAILING ADDRESS:�3 3 o e1=5 r e r•�- CITY: �_Xc�/S�o� ZIP: 55'33 r <br /> STATE LICENSE: # 3 5 $ Z EXPIRATION DATE: <br /> ARCHITECT/ENGINEER: KC.� �e�vt(� E�eE S I 4 � PHONE: `-�� � �I S�Z <br /> MAILING ADDRESS: �S/� 7 7Th S T . CITY: ��S�A ZIP: 5�31$ <br /> NAME: REGISTRATION: # <br /> TYPE OF WORK: New Home Addition Accessory Stcucture <br /> Move Home Remodel/Alteration (ie: Siding, Windows) <br /> Any earth movement may require MCWD review and permits ! <br /> PROPOSED WORK(rlesc��ibe in rletain: Ti ti-/Sl� 3J45E 1M►��% <br /> STORIES: O SQ.FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS: _Q_ GARAGE STALLS: ATTACHEll DETACHED_ <br /> .�o <br /> ESTIMATED CONSTRUCTION VALUATION(excluding tand): $ 3� OC� <br /> I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; <br /> that the work���ill be in conformance�vith the ordinances and codes of the City and.with the State Building <br /> Code; that I understand this is not a permit and���ork is not to start without a pern�it;and that the work will be <br /> in accordance with the approved plar��� <br /> APPLICANT'S SIGNATURE: � DATE: 5^' ���_ � 7 <br /> 31 <br />