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DateReceivea: <br /> �, otal Fee: 5 � �,' �`� �� k' DateApproved: <br /> � ' <br /> � <br /> � Entered By: `� Permitn: 7/ (�✓ �/ <br /> � CIT�.' OF ORQti O - BL'ILDLI�G PEF..�VIIT APPLICATION <br /> .�,.LL Lti�ORtiI_ATIO���IL'ST BE SLBi��iITTED L\�FULL BE�'�RE pL�'� ��'�ti�'��'�'L <br /> BE ST:�RTED <br /> --------------------------------------------------- <br /> ---- - - - -------------------------------------------- <br /> THE .�PPLIC��1T IS: (circle one) OW��ER CONTR�CTOR <br /> JOB SiTE aDDRESS: ��9 c1 /�lG� �OQ� '�� Z�: SS 3 6`� <br /> �idd�✓D <br /> N�tiiE OT O`��lER: <br /> �L 5�,�}�.J PHONE: (home) �}72�Z17v <br /> (work) SS7-9 2 v <br /> �I:�IL1�G:�DDRESS: /aZ�'7S5 57�"%� f�/'�v�i��ITY:�yrkodi� ZIP:�� <br /> �� <br /> �W iN-�'2 <br /> CONT CTOR: � S PHON`E �-L-�-�S�? <br /> ��IpBILE PHO?��E/PAGER: <br /> �'IAILL�G ADDRESS: t_ _CITY: !^�t r�/ Zg'��—� <br /> ST:�TE LICE\SE: � D � � �`�'��'� <br /> �P.CHITECT�'ENGL\�EER: 1�wt e o<.,/.�/�-- PHO�`E: <br /> CITY: Zg':--- <br /> 11-�ILL'�GADDRESS: REGLSTR�,TIO�i r <br /> \:�1LE: <br /> �dditior. Ac,.essory Structure <br /> TYPE OF �VORK: �e��' _� Remodel/Alteration Larxi Alteration <br /> Move <br /> PROPOSEDWORh(describeindetail): �{,;v���c �" is��"��'' �T��'�i�� <br /> /� � G !i/f liG v✓► %�} J��� �D/'�l i <br /> �0 �' Dr�.o.ti�, .4-�c�S -rJ �J/yrr✓:..,�� <br /> STORIES: __Z___ SC?• �ET OF EACH FLOOR: C/�`� <br /> NO. O�' BEDROOi�1S: Z GARAGE STALLS: ET•—X- �X�S��"�w <br /> F/N/S� �/D�.1Lrlith!�G-7i T7/�G C//S/r/✓�/6 S�G� <br /> E�I'Ll1ATED CONSTRUCTIO\VAI,UATION(escludingland): � ��, O� O <br /> I hereby apply for a building permit and I acknov.�ledge that the information above is cemnlete <br /> and accurate; that the work will be in conforma�.ce with the ordinances and codes of the Ciry <br /> and with the State Building Code; that I understand this is not a permit and work is not to start <br /> without a permit; and that the work will be in accord ce with the approved plan. <br /> ' � DATE: 7 7 <br /> APPLICr��tT'S SIGNATURE: <br /> t NOTE! Parcide of=es events require separa e permit approval ba Police Department and <br /> Cin� Council 60 da��s prior to the event. Non permitted events will not be allowed. <br /> 9 <br />