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CITY OF ORC:70 - BUILDI:7G F��=-�Ii t�.pPLIGaTION <br />'ota? Fee: $ �U <br /> fr�/ Date Received: ��'/O ' �� <br /> Da�e A��rovec : <br />-z�.�,-Aa �v: �-'-� '�/ <br /> Fe�.-mit�- � � <br />;_I,y INgOg.MATION MIIST BE SIIBMITTED IN FUI,I� BE.FORE PI�N RE�7IEW WII�L B$ STARTED <br /> (See Check-ar= List �nclosed) <br /> ---------------- <br /> ----------------- - <br /> -gE p,ppl,IC.�NT IS: (circle one ) G�v"�IER or CGNTRACmOR <br /> ZIP: <br /> qB SITE ADDR.SSS s <br /> (work) <br /> PHONE: (hcme) <br />'?,I�? OF OWNER: <br /> •�ILING ADDR.ESS: <br /> CIZ•y: Z IP: <br /> PH�NE: <br />'�N�tACTOR: <br /> C=�: ZIP: <br /> �II�SNG ADDRESS: <br />:TATE LICT'NSE: _ <br /> PHONE: <br />'�CHITECT/ENGINEER: <br /> _;II.ING ADDRESS: <br /> CITY: ZIP: <br /> REGIST?�TION � <br /> .�iE: <br /> YPE OF WORR: i7ew Addition Accessory Structure �iove <br /> De:no Re*nodel/Alteration Renovate Larid Alteration <br /> ?OPOSED WORR (describe in detail) : <br />;TORIESs SQ. FEET OF EAC$ FLOOR= <br />;O_ OF BEDROOMS: GARAGE ST�S: ATm, DET. <br />,�Ty�,�ED CONSTRQCTION VALIIATION (egcluding Iand) : $ <br />" hereby apply for a building permit and I ac?cncwledge that tne in�or�ation <br /> �ove is complete and accurate; that the work wi? ? be in conforznance with the <br /> rdinances and codes of the Citv and witn the State Building Code; `�at T <br /> Zderstand this is not a per�it and work is not tc start without a per�it; and <br /> aat the work wi1 I be in accordance with tne approved plan. � <br /> - DATE: <br />�_PPLICAP7T'S SIG:IATURE: ' <br />