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� <br /> Total Fee: $ � � 2�' � Date Received: 'f-3G �' 3 <br /> ' Entered By: Permit #: ��,/02.5,3 <br /> �%`1,��V - �'�L -� <br /> CITY OF OR O - BUILDING PERMIT APPLICATION <br /> � All information must be submitted in full before plan review will be started. <br /> (please print all information) <br /> THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR <br /> JOB SITE ADDRESS: 1 (. � u ��>la-l�� C��2 ( ZIP: <br /> NAME OF OWNER: �'l �� C- � t�t�7 v"` iZ-- PHONE: (home) �S 1�y 3�� 3�13 c <br /> (work) <br /> MAILING ADDRESS: Z t I �, V`'l y,'L�I �-S�. CITY: S J�,�1(�G.��ZIP:__`i�.�Z <br /> w, <br /> CONTRACTOR: pv��i l�-r�r 6— �-1���5 i L rG� � PHONE: �,.�I `�3 �' `� ��3 � <br /> CONTACT PERSON: -��� �,�6v' � MOBILE/PAGER: (o r�- 27 �j -Z� �y <br /> MAILING ADDRESS: 7� � �, /'h yr2-f�� S/- CITY: S�`�/lc�Cc�t'�Z ZIP:��Z <br /> STATE LICENSE: # Z�o(��-�'t!�� <br /> ARCHITECT/ENGINEER: ta r✓I C��!-�C� Pl 7 f�/f t2 PHONE: ��L �3�� ���'� <br /> MAILING ADDRESS: 1 z-�1) ���+2. 5�1� MIIIS CITY: ��r�l�,��r10 ZIP: ��3/� <br /> N��ME; REGISTRATION# <br /> TYPE OF WORK: New J� Addition Accessory Structure <br /> Move Remodel/Alteration Land Alteration <br /> , <br /> PROPOSED WORK(describe in detain: '��.�✓ `�� � !�/� �✓�� <br /> STORIES: � SQ.FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. <br /> �v <br /> ESTIl��ATED CONSTRUCTION VALtiATION(excluding land): $ � �� t �� . <br /> I hereby apply for a building permit and I acknowledge that the information above is complete and <br /> accurate; that the work will be in conformance with the ordinances and codes of the City and with <br /> the State Building Code; that I understand this is not a permit and work is not to start without a <br /> permit; and that the work will be in accordance with the approved plan. <br /> -� <br /> APPLICANT'S SIGNATURE: DAT'E: �" �� `I� <br /> NOTE! Parade�Homes events require separat permit approval by Police Department and <br /> Ciry Council 60 days prior to the event. Non permitted events will not be allowed. <br /> 9 <br />