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�ata1`�ee: � Date Received; <br /> nter�d �y: Permit#: <br /> CYTY QF OR.C�N(] - BI3�LD�NG PERMY7' APP�.,ICATIQN <br /> A.]� infornnation must be submitted in fiill before plau re�iew will be s�arted. <br /> � (please print all information} <br /> 'I'i�E APPLICANT YS: (circle ort�� OWIVER d CONTRAC'Z'OR <br /> �o$ sY�rE a.�D�SS: z�: �S � 1 <br /> 1�T,A.1kIE �F UWIVER: ���������27�_�.�YV PHO?VE: {hame) S -y /��/y <br /> , (ti�ork)�/lll-�07�-�'8� <br /> �IAILING ADDR�SS: I9�� �� r�CYTY: ��: ss�g� . <br /> co�.ACTaR: � . pxox�: �S�-7 y�-�s�-/d <br /> CON'rACT P'ER�SON: �4BTL�/PA�ER: �S/-o2 -`I Co <br /> �1AII.ING AT?DRFSS: ` C�'Y:���n�.�,Q.�u-�- ��:�� <br /> STATE LICEl�'SE: #._,�/�S-� 9 � <br /> ARC�iTT`ECT/ENG�IT�TEER: PHO►NE: <br /> IVJA,,TT,�TG AD]�RESS: CITY: _ �]P: <br /> NAME: --- REGISTRATION#� . <br /> Typ� O�' WqR�K: Ne�cv Addition Accessory Structure <br /> Move Remode�lAlt�ration Lan.d Alteration <br /> pRa SEI�'W(]RK(describe irc detai�; /i.�irvr.r�f �— 1 -� �'�1 -- <br /> � <br /> STQRIES: � S¢.FEET OF EACH�'I.QOR: <br /> Nb. O�` BEDRQOMS: GARAGE STAr.Ls: ATT. D�x.� <br /> ESTIMA.TED CONS'T�2�UCTION VAI.�iJATYON (e�►cludiung land): $. � J��.(� <br /> Y hereby apply for a huilding perm.it and I acknowledge that the iaformation�bo�ve is complete and <br /> accurate; tl��t the work will be in cont'ozmance with the ordina.uces and codes of rhe City and w��h <br /> Khe State Building Code; that � understa�nd tkt-is is not a ger�riit and work is not to start wirhout a <br /> permit; and that the wark will be in 2�c aYdance �vith th� approved plan. <br /> A�'pLICANT'S S�GNAT�CT'R�: DA.�: 3 <br /> NOTE! Parar�e of I��� events re�quire separate pernut approval by �olice Depanrnent and <br /> Gity �'ouncit 60 days prior to the event.� Nan permxt�ed events will nnt be allawed. <br />