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09/22/05 15:21 FAX 6516282705 SECURE COMPUTING HR C�001 <br /> �— �: <br /> �2`� � '�� � c��. i � � �': <br /> �c .�� � , <br /> � � � r <br /> ' `��e�3e�rh a�d I <br /> Total Fee• $ 5� �-� Date Re�eiv ec�: 9-�a-o�- <br /> Entered By: �� Permit#: _ �D��/ 3 <br /> CITY OF OItONO - BUILDING PERMIT APP:GI[CATION <br /> All information cniust be submitted in full before plan revie���will be started. <br /> (please print all informatian) <br /> ----------------------� -- ------------------------------------- <br /> THE APPLICANT I5: (circle one) OWNE OR CONTRAI�TOR <br /> �/ � <br /> JOB SITE ADDRE55: �r � C � �Zu': o <br /> Will this be a P rade of�[omes,Remodelers 5howcase Home or otl�er Display Home? <br /> ❑ Yes �NO If yes, a special event permit is required with Police Department and City Council approva! <br /> �� 60 days prior to the event. Shuttle bus service wi11 be requir�rclunless applicant demonstrates <br /> su�ci�ent on-site parking is available. Non permitted evenis tivill not be allowed. <br /> r 1 9�Z'^ <br /> NAME OF OWNER: I�'� � �f•�b1 G�Y' � PHOlWE: (home) �I�G�-�7?--� <br /> , (work)6�J-6�8�27�7 <br /> MAILING ADDRESS: �� b C ��.� ���CITY:�'Y�Sf'�ZIP: � <br /> CONTRACTOR: P����� <br /> CONTACT PERSON: _ MOBILE/PAI;�ER: <br /> MAILING ADDRE55: CITY: __ ZIP:- <br /> STATE LICENSE: #_ EXPIRATION D Ai CE: <br /> ARCHITECT/ENGINEER: �/� P�[�NE: <br /> MAILING ADDRESS: _ CITY: _ �P� <br /> NAME: REGISTRA'I'lON: # <br /> TYPE OF WORK: Ne��v Addition ��ccessory Structure <br /> Move Home RemodellAlterati��n. �_ <br /> i ��SV1�I V1 � �.� �� <br /> PROP F,D WORK(des ribe in de ta • _. <br /> ' c510� �b- 'In c! _e <br /> -k � �� <br /> STORIES: �_ SQ.FEET OF E H FLOOR: �pl�� � � <br /> NO. OF EEDROOMS:_� GARAGE STALLS: ATTACHEG Z• DETACHED_ <br /> ESTIMATED CONSTRUCTION VALUATION(excluding land): '6. <br /> I hereby apply for a buildin�permit and I acknowledge that the information a b�ave is complete and accurate; <br /> that the wozk will be in confformance with the ordinances and codes of the City and with the State Building <br /> Code;that I understand this is not a p it and work is not to start without a pennit;and that the work will be <br /> in accordance with the approved pl . . <br /> APPLICANT'5 SIGNA�CURE: ` II.A,TE: -r 2 � . <br /> 31 <br />