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May 10 05 07: 39a p, l <br /> , <br /> /� � ' J <br /> ��,� <br /> Tota!Fee: � / � � ����` � T�-��� Date Received: k�J �-- � <br /> Entered By: ��' '�� Permit#: =% ,L_ / �'� '`/ <br /> 0��1'�'. <br /> CITY OF OROl\TO - BUILDING PERMIT APPLICATION <br /> All information must be submitted in full before plan review will be started. <br /> (please print a[I infornzatio�T) <br /> ----------------------------------------------------------------------------------------------------------------------- <br /> THE APPLICANT IS: (circle one) OWNER R CONTRACTOR <br /> JOB STTE ADDRESS: � (OC� % U� S� ZIp; <br /> Will this be a Parade of Homes,Remodelers Sho�vcase Home or other Display Home? <br /> ❑ Yes �O If yes, a special evenl permit ts��equired with Pofice Deparvnen[and Crtv Coiincll appi•onal <br /> 60 days prior to the eve�zt. Shzrttle bus service wi!l be required ttxless applicant demonstrates <br /> s�ffcrent an-site parlcii�g is avnilable. ,�'on-permitted evenls tivill na1 Ge a(lorved. <br /> NAME OF OWNER:l 2 �J PHONE: (home) <br /> ,,1 (worlc) <br /> MATLING ADDR.ESS:y,�6 Q G'RC�t�t�P�I /CU CITY: G1P('JIUO ZIP: �� I <br /> C�NTRACTOR: !//l•� G�,��ve�-}-- PHONE: �ia -7o�1-3y�� <br /> CONTACT PERSON: � /1 R e M08ILE/PAGER: S��{� <br /> iV1AILING ADDR.ESS: 3 �`' �U CITY:/�JA,p/e. �'o p ZIp; SS3// <br /> STATE LICENSE: # EXPIRATION DATE: <br /> ARCHITECTiENGINEER: /�,��,�j s/7 e f� PHONE:��-2 �� �y-ya yz <br /> MAILING ADDR.ESS: /OQ �V. G�''`,g- �G Sa C CITY: 11'�L�S ZIP: Ss-�p 3 <br /> N�M�� REGISTRATION: # <br /> TYPE �F WORK; New Home Addition Accessox•y Structure <br /> Move Home Remodei/Alterltion (ie: Siding, Windo�vs) ✓ <br /> �.ny earth movement may require MCWD review and permits ! <br /> PROPOSED WORK(describe i�: derai�: �Pn�reile l .�y7�iC/OK f �r�De Q� ,Sam� <br /> _LiJ I�'.LL�S A*�Q I'Y►iu�ria�irC STRu�T-v r►-1- Z"'•v�7�,GG.rr�g�v <br /> STORIES: Z... SQ.FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS: � G�G� STALLS: ATTACHED D�TACHED� <br /> ESTIMATED CONSTRUCTION VALUATION(excluding land): $ ���,�Q�'J <br /> I hereby apply for a building permit and I acknowledge that the inforination above is co�nplete and accurate; <br /> that the work will be in conformance w•it11 tlie ordinances and codes of Yhe City and w�ith the State Building <br /> Code;that I understand this is not a perinit and work is not to stact without a pennit;and that the�i�ork will be <br /> in accordance with the approved plan, <br /> i' <br /> �- ---- <br /> APPLICANT'S SIGNATU . � DATE: � -�-� 'd� <br /> 3l <br />