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� � <br /> CITY OF ORC.70 - BUILDIiIG FER�T A.PPI,ICATION <br /> Total Fee: $ � ' \�' � ` Date Received: <br /> Date A�pro�ed : <br /> � - - <br /> vntered Bv: � <br /> Permit r: ��� �' � <br /> ALL INFORMATION MIIST BE SUBMITTED IN FIILL BEFOR.E PLAN REVIEW WI?�L B$ STARTED <br /> (See Check-aff List Encl.osed) <br /> ------------------------------------------ <br /> ------------------ __ _.._..., <br /> THE A.PPLICANT IS s (circle one) �,�1NEI�.%or CONT�ACTOR <br /> � ,� <br /> JOB SITE ADDRBSS: ��S`J �NS�'� ���. ��i� . ZIP: S � > ~� I <br /> (work) <br /> � <br /> N�ME OF OWNER: �-��`� ,`"�� PHONE: (home) �/7�"v ��� <br /> MATZING ADDRESS: CITY: ZIP: <br /> CONTRI�CTCR: pH��' <br /> MATI�ING ADDRESS: CSTY: ZIP: <br /> STATE LICENSE: � <br /> ARCHITECT/ENGINEER: PH��' <br /> MAIZING ADDRESS: CITY: ZIP: <br /> NAME: REGISTRATION z <br /> TYPE OF WORR: New Addition Accessory St�yucture blove <br /> Demo Remodel/Alteration Renovate � Land Alteration <br /> PBOPOSED WORR (describe in detail) : �� �°�'� <br /> STORIES: SQ. FEST OF EACH FLO�Rr <br /> NO_ OF BEDROOMS: Gs'�RAGE STALLS: ATT. DET. <br /> ESTIMATED CONSTRIICTION VALIIATION (ezcluding Iand) : $ �"v0°•�`� <br /> I hereby apply for a buiiding 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 Buil.ding Code; that I <br /> understand this is not a permit and work is not to start without a permit; and <br /> that the work wi1 1 be in accordance with the approved plan. � <br /> ,���APPZICANT'S SIGNATIIRE: �=� DATE: C�'�7' f�-- <br />