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CITY OF OROI3�U '- �iUILDING PERMIT APPLICATION <br /> Total Fee: $ 4 3 � ��S� Date Received: <br /> � Date Approved: <br /> Entered By: �'�'� Permit tt: � G �� <br /> AT•T• INgpRMATION MIIST BS SIIBMITTED IN FIII�L BEFOR.E PLAN RE�7IEW WILL Bg STARTED <br /> (See Check-off List Enclosed) <br /> ----------------------------- <br /> -------------------- <br /> ------------------ <br /> THE APpI,ICANT IS: (circle ane) O�dNER �NTRACTOR <br /> �� 1�.� �/�i11�IA � /�'� �l�) 7ilp: <br /> JOB SITE ADDRSSS: /�.� ✓ ��� vw <br /> (work) <br /> �. J oh rv ��h���"�Sll�l� PHONE: (home) <br /> NAME OF OWNER: !�V D <br /> MAILING ADDRESS: �7�� I�P.`lt'_,�' J Ar��W� CITY: (���I�JY� ZIP: <br /> - `^ ;,�-I � � PHONE:� � �".� � 1 � <br /> CONTRACTOR• � �"� <br /> MAILING ADDRESS: � 75 �-S p, � � 1 _ CITY: J�t.�;Nl�� ZIP: _ <br /> STATE LICENSE: # ��C��-�S� <br /> PHONE: <br /> ARCHITECT/ENGINEER: <br /> MAILING ADDRESS: <br /> CITY: ZIP: <br /> NAME� REGISTRATION ,ur <br /> TYPE OF WORR- New Addition Accessory Structure Move <br /> Demo Remodel/Alteration � Renovate Land Alteration <br /> PROPOSED <br /> WORR (describe in detail) : � � ��1 r Q �r ���% � � ()2)� �NS���� <br /> ' " � � � ►� � r � Z�s P b�. � � z��� <br /> �S�� �n;��,�, M � �, r� � � �.� � �. <br /> r��w� rvr>�� s�sf4v� . <br /> STORIES: SQ. FEET OF EACH FI+O�R= <br /> NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. <br /> � <br /> ESTIMATED CONSTRIICTION VALIIATION (excluding land) : $ � �� <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 wi�ha�hl <br /> ordinances and codes of the City and with the State Building Code; <br /> understand this is not a permit and work is not t start without a permit; and <br /> that the work will be in cordance with a r ved plan. <br /> ` � C� <br /> � � DATE: IC�"�� / � <br /> APPLICANT'S SIGNATURE: �� ' , <br />