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CITY OF O�C37Q -- BUILDING PERMIT APPLICATION <br /> i;) <br /> Total Fee: $ ��� � "� Date Received: <br /> Date Approved: <br /> Entered By: � / � <br /> Permit n: y7 �.:� <br /> AT,T• INFORMATION MIIST BE SDBMITTED IN FIILL BEFORE PLAN REVIEW WILL B$ STARTED <br /> (See Check-off List Enclosed) <br /> ---------- <br /> ---------------------------- <br /> ------ --�-_._�------------------------ <br /> TgE APPLICANT IS: (circle one) 0��7NER or Q�TR�ACTO_ R �, <br /> JOB SITE ADDRBSS: �� '�- F . cr -E !/�-�� ZIP: <br /> (work) <br /> NAML OF OWNER: � r ,�: � PHONE: (home) <br /> MAILING ADDRESS: / �� ��e� � ��: P LN CITY: (�� ZIP:�y���� <br /> CONTRACTOR: �c�r � c, �' �� � � � � PHONE: L/ 7/'- %/�"��- <br /> MAII�ING ADDRESS: -5/� �, c�G�c�-� /�l`/ � F CITY: �-'�c u,J cI ZIP: �;�_,��v y <br /> STATE LICENSE: � �-/�I�� <br /> ARCHITEC�'hC�NGINEER: PHONE: <br /> MAILING ADDRESS-��``�--- CITY: ZIP: <br /> NAME: ` REGISTRATION n <br /> TYPE OF WORR: New Addition Accessory Structure Move <br /> Demo Remodel/Alteration � Renovate Land Alteration <br /> � - /cG F c�., _ _ d� <br /> PROPOSED WORR (describe in detail) : /<�.a-�o��� �-- �f-� - <br /> STORIES: SQ. FEET OF EACH FLO�Rs <br /> NO_ OF BEDROOMS: GARAGE STALLS: ATT. DET. <br /> ec� <br /> ESTIMATED CONSTRIICTION VALIIATION (ezcluding land) : $ �Cj%�?�� — <br /> I hereby apply for a building permit and I acknowledge that the information <br /> above is complete and accurate; that the work will be in conformance with the <br /> ordinances and codes of the City and with the State Building Code; that I <br /> understand this is not a permit and work is not to start without a permit; and <br /> that the work will be in accordance with the app r ed pl n. � <br /> . /9 / y','�/ ��.___. . . . <br /> APPLICANT'S SIGNATURE. �— DA�: i�'� - �� <br />