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� CITY OF OROl+IO - BUILDING PERMIT APPLIGATION <br /> • Total Fee: $ /�j `��% _ Date Received: <br /> Date Approved : <br /> Entered By: ,('/��' <br /> ' Permit#: `�3���- <br /> AT•T• INFORMATION MDST BE SIIBMITTED IN FIILL BEFORE PLAN REVIEW WII,Z BS STARTED <br /> (See Check-off List Enclosed) <br /> ----------------------------------- , --------------------------------------- <br /> THE APPLICANT IS: (circle one) �OWNER r CONTRACTOR <br /> JOB SITE ADDRESS: ,�Jrl y ��v-S�/�C �� ZIP: v� ��y� <br /> (work) 3�(l � 73/�> <br /> NAME OF OWNER: ���/�5�� /� �i''%S r�/C PHONE: (home) �7/ ��-�� <br /> MAILING ADDRESS: ��5�� (�P.�ST.�L �C CITY:�Z�%a ZIP: S -�� 39/ <br /> CONTRACTt1R: PHONE: <br /> MAILING ADDRESS: CITY: ZIP: <br /> STATE LICENSE: # <br /> ARCHITECT/ENGINEER: �'H��= <br /> MAILING ADDRESS: CITY: ZIP: <br /> N�yg: REGISTRATION # <br /> TYPE OF WORR: New Addition Accessory Structure Move <br /> Demo Remodel/Alteration Renovate Land Alteration <br /> / <br /> PROPOSED WORR (describe in detail) : ��� �' �ft� �� <br /> <�/r� ��i" aCi' ���; �r�i .�/�%�/ �/���cc rc 5 <br /> STORIES: I SQ. FEBT OF EACH FLOOR: <br /> NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. �- <br /> �C� <br /> ESTIMATED CONSTRIICTION VALIIATION (ezcluding 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 with the <br /> ordinances and codes of the City and with the State Building Code; that I <br /> understand this is not a permit and work is not to start without a permit; and <br /> that the work will be in ac,Eordance with the approved plan. � <br /> � <br /> T' SIGNATDRE: y' ���� /� � � DATE: ,S-/.�- �� <br /> APrLICAN S l <br />