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Total Fee: $ ��(�- � g� Date Received: ,�l'� 9l v�/ <br /> Entered By: �-�/� Permit#: �Qp '75 �„ <br /> �Y���' � �`"� ���`���`� <br /> CITY OF OR(�NO - BUILDING PERMIT APPLICATION <br /> All information must be submitted in full before plan review will be started. <br /> (please pri�it all informatio�z) <br /> ------------------------------------------------------------------------------------------------------------------------------- <br /> THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR <br /> JOB SITE ADDRESS: /'��� ,�,��i��.� ��.� zTp: J�;���, <br /> Will this be a arade o�_Homes, Remodelers Showcase Home or other Display Home? <br /> ❑ Yes o If yes, a special event permit is reqziired with Police Department and City <br /> Council approva160 days prior to the event. Non permitted events will not <br /> be allowed. <br /> NAME OF O«'\'ER: ST���- •'��s_c,'�n/ PHONE• (home) y�Z -`�7G �-�c� � <br /> (work) <br /> NIAILING ADDRESS: �r�-� �= CITY: ZIP: <br /> CONTR.ACTOR: ���� �,,.., �o��, �,.,5�rs:���� PHONE: � �z -2-z� -3;�f,.S <br /> CONTACT PERSON: J «-� MO�ILE/PAGER: <br /> 1VIAILING ADDRESS: /3«� zK�z����- 8�v� CITY: � ��-.� ZIP: <br /> STATE LICENSE: # <br /> ARCHITECT/ENGINEER: PHONE: <br /> MAILING ADDRESS: CITY: ZIP: <br /> NAME: REGISTRATION# <br /> TYPE OF WORK: New Accessory Structure � <br /> Addition Move <br /> RemodeUAlteration Land Alteration <br /> PROPOSED WORK(describe i�z detai�: _�,v5��y� ���,��, �i,,%� ,�'o <br /> STORIES: ""��� SQ. FEET OF EACH FLOOR: _ 7 C�� X � G � <br /> NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. <br /> ESTIMATED CONSTRUCTION VALUATION (excluding land): $ t �10 W� <br /> I hereby apply for a building pemut and I aclrnowledge that the information above is complete and accurate; that the <br /> work will be in conformance with the ardinances 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 that the work will be in accordance with <br /> the approved plan. � <br /> �I�'� / <br /> APPLICANT'S SIGNATURE: %J � %�s DATE: lv � G'� <br />