Laserfiche WebLink
� `"`� Z��° �°� _ <br /> � <br /> Total Fee: $ 1 a8•7S Date Received: 2- ID -D� <br /> Entered By: Permit#: /�072-2Z- <br /> CITY OF OR0�10 - BUILDING PERNIIT APPLICATION <br /> All information must be submitted in full before plan review will be started. <br /> (please print all infor�nation) <br /> -------------------------- <br /> THE APPLICANT IS: (circle or:e) O�VNER O � ONTRACTO$J <br /> ' 6 � <br /> JOB SITE ADDRESS: �5�� � �� ��-��,5�z�s--, � -r ZIP: S� ` i/ <br /> `Vill this be a Parade o€Homes, Remodelers Showcase Home or other Display Home? <br /> ❑ Yes � i To If y�es, a special event permit is reqi�ired with Police Department and Ciry <br /> Cauncil approval 60 days prior to the event. Non permitted events will not <br /> be allowed. <br /> NAIVIE OF O�'NER: � :-;'i.:�_� � ;_��``� PHOl�'E: (home) 5�5 Z -Si�i- <br /> _. �''�'�'� <br /> - (work) <br /> MAILING ADDRESS:_�S.S i C�� . �f.,,�� -',,.. CITY: „ _l/��-;__�� ZIP: ;�� �,s �-� <br /> CONTRACTOR: , ,�e� �= -,.r .J �,..4�l 4. PHONE: '�',�_,� _ �i�> > --'�'�; <br /> CONTACT PERSON: . � •� � .� . `IOBI /PAGER: ��5>`- yC S=5',�° ���.. �- <br /> MAILING ADDRESS: �_��'S�� 1��,� CITY: ,.���-..u�''/ ZIP: SS�"s'� � <br /> STATE LICENSE: # ��/�" <br /> ARCHITECT/ENGINEER: PHONE: <br /> MAILING ADDRESS: CITY: ZIP: <br /> NAl�IE: REGISTRATION # <br /> TYPE OF�VORK: New Accessory Structure <br /> Addition f..... 1love <br /> RemodeU_�lteration L''J Land Alteration <br /> PROPOSED WORK (describe in detai�: _ - -� -' � � <br /> r� � E-� --•� ,-./,1 %l��•F <br /> _��`./'/_7i�"/�F/ /�`�f�y l[� ..i( �L� c�.rc [' �\• _� � � . .�+_ <br /> r, <br /> �- X �) \ r� <br /> y/ r.r:/.',� ._ F�E-<,�"�' <br /> STORIES: �_ SQ. FEET OF EACH FLOOR: <br /> NO. OF BEDROO`IS: GARAGE STALLS: ATT. DET. <br /> ESTI�IATED CO\STRUCTIO\ VALUATIO�' (excluding land): $ �����r ,�'� <br /> I hereby apply�for a bui?ding perm.it z.d I acl�owledge that the information abo��e is complete and accurate; that the <br /> �vork �vill be in conformance «zth t�e ordinances and codes of the City and with the State Building Code; that I <br /> understand this is not a permit and�-ork is not to start w-ithout a permit; and that the work�vill be in accordance with <br /> the approved plan. � <br /> �� ' � ��s <br /> APPLICANT'S SIGNATURE: � � ;ii��.,/"�j��. <br /> „ � DATE: _�-- /C; '_ �;� <br />