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Apr-OA-2004 09:13an From-CITY OP OR�10 +9512<Ad616 T-035 P.00Z/003 F-735 <br /> r <br /> 7�� _�}l� <br /> � � Date Received: (y� �� — <br /> 'Total Fee: $ Permit#: �(1�7(U�i( <br /> � Entered Sy: _ �'� � <br /> CITY OF OR4N0 -BUILDING PE�tMIT APPLICA'rION <br /> All information m�st be submitted in fall before plan review wiU be started. <br /> {please print all infarmation) �w� <br /> .___.-----� --- <br /> ___._---------- <br /> TI-��APPLICANT TS: (crrcle one) OWNER U CUNTRACTO � <br /> JOB SITE aDDRESS: <br /> �-�f'i'1 1 c�. E' � ZIP: <br /> Will this be a Par de oi I�omes,Remodelers SLowcase Home or other Aisplay Home? <br /> (� y�s (�No If yes, a special event permit is required wfth Police Department and Ciry <br /> ►` Council approval 60 days prior to the event. Non permitted events wil!not <br /> be allowed. <br /> NAME OF O'�VNEYt: - .'�� � "� r � ��U Y' � PHONE: (home) <br /> (work) <br /> •-- ��� � -L ��ITY: C��(' -,_�n C'� ZIP: <br /> MAYLING ADDRESS: �. <br /> ,/1 ��„ �n1-� �j!��; PHOI�: ��'� ��-I�i 3-��]' <br /> CONTRACTOR: <br /> COIVTAC"Y'PERSON: � ��i� MOBII.E/P GER: q-�Z Z�1� `x�4 <br /> SS: Z Z �`� � CITY: ZIP: 5 . �`� <br /> MAILING ADDRE • c <br /> STATE Y.ICENSE: # - z � <br /> --� �. ,m____�!_— _�HONE: �7, � . , '� � L7 <br /> �ARCHYTECT/ENGYNEE�t: f „ � CITY: =-ti ZYP: �5UL <br /> IIrIAYLII�TG ADDYtESS: �Z'' ��ISTRATION# <br /> � NAM�: <br /> ���,� ;, ` <br /> Accessory Structure _� <br /> TYPE OF WOR�C: Ne'R' � �ove <br /> Addition � <br /> �temodeUAlteratiog Y,and Alteration <br /> pROPOSED WO�(�scribe in detai!'): ''�, ' <br /> 3TORIES•_,_ SQ• FEET OF EACH FLOO�t: <br /> NO.OF BEDROOMS:` — GaR�►GE STALLS: ATT. DET. <br /> ES'!'I1VIATED CONSTRUCTION VALUA'rION(exclAding land): S �,�,��,..,�°�C 1 � <br /> i hereby apply for a building permit and T aclrnowledge that�e information above is complete and accurate;that the <br /> work vui11 be in conforn�anCe with the ordinaitces 2tr►d eodes of the Ciry and with thc State Building Code;that I <br /> understand this is not a ptrmic and work is not to staR without a pcctml;and that the work will be in accordsnce with <br /> tht approvcd plan. <br /> � ��� ,c�z- DATE:�- - ,� <br /> pPpY,ICANT'S SIGNATURE: — <br /> � � <br />