Laserfiche WebLink
T�r.al Fee: $ .3��• 9 � DateReceived: ' <br /> � � Etttered B � a3 � , <br /> Y= Permit#• D yg � <br /> o�' q'��'�b CIT'Y' OF OR N - <br /> � ��a,{ O O BUILDI1vG PERNIIT APPLICAI'�ON � <br /> �y AU information must be snbmitted in �hil before plan rcview will be started. � <br /> (please print all tnformation) <br /> THE APPLICAIV'T YS: (circl�one) OWNFR O CONTRACTO�L <br /> JOB SITE ADDR,�SS: a��0 �Q, �p: � <br /> Will this be a Parade of Homes,Remodelers SLowcase Home or otber Display Home? <br /> ❑ Yes ❑ No If yes, Q special evenr pernrir is required wilh�Police Deparlment and Ciry <br /> Counct!approva160 daysprior to rhe event, Non pernlitred events will naa <br /> be allowed. <br /> N� os ovvr�R: � ��a-`f 7/- �5R' `�- <br /> PHON�: (home) � <br /> (Work) (�-�3 - ,a-� 7�Ut�-. <br /> NIAXLri�TG A.DDItESS: CITY: ZYP: � <br /> � <br /> i <br /> CONTRACTOR: PHONE:(0 5�' 7 'a b �,(� <br /> CONTAC�'P�12SON: MOBII,�/P �ETt: <br /> MAILING ADDRESS: C�y.. <br /> STATE LICENSE: # � ZIP: a/ <br /> ARCYiI'TECT/ENGLNETR: pgp�; <br /> MAILING AUDRESS: CITY: ZIP: <br /> NAME: � REGISTRAT'ION# � � <br /> TYPE OF WORK: New Accessory Structure � � <br /> � <br /> Addition Mo�►e <br /> RemodeVAlteratioo � Land Alteratiou . <br /> � <br /> PROPOSED WORK(describe in detai�: ..9 �'�Q,Q,�,�� <br /> L � � <br /> STORXES: SQ.�+'EET OF EACH FLOOR: <br /> NO. OF BEDROOMS: � G.�R�GE STAI,LS: ATT. bET. <br /> ESTIII"1ATED CONS?RUCTION VALUA�'TON(ezcluding lan�: s I g. 3 ��• D � <br /> I hereby apply for a building permit and I acl�owledge that tho info►Tnation above is complete and aeeurdte;ths��ho <br /> work will be in eonformancc with the ordinances and codes of the Ciry and wich the State Building Code; tbac I , <br /> understaad this is not a pernzit and work is r�ot ro statt withoett a permit;aad that the work a►ill be in accordance with <br /> the approvod plan. <br /> � I <br /> APPLICANT'9 SIGNATURE: DATE: r�3 JO � <br /> 1D0/i00 'd LS � �i (�N�)b002-�Z-d�S <br />