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..,� '�►' <br /> : , �, � � <br /> Total Fee: S �J�)�y � % DateReceived: la-�-v � <br /> Entered By: �'Vt� Permit#: �-�,���(9� <br /> � ^ L`' CITY OF OROti O - BLZLDL�IG PERIVIIT APPLICATION <br /> ��� ;ui�� <br /> 1 y � All information must be submitted in full before plan review will be started. <br /> (please prinl all information) <br /> __ <br /> ----------------__-------- -- ------- -------�-�--c-==---�------------------------------------ <br /> THE APPLIC�'�1T IS: (circle one) O�`1�ER OR CONTRACTOR <br /> � __._�.___.________--� <br /> JOBSITEADDRESS: CvC' � ��. nne�";,��GC2 ��,;•�,/�n.� � '-,�._ ZIP: � 7 .? �C <br /> Will this be a Parade of Homes, Remodelers Sho�-case Home or other Display Home? <br /> ❑ Yes � I�ro If yes, a special event permit is required with Police Department and City <br /> Coi�rtcil approl�al 60 days prior to the event. Non permitted events will not <br /> be allowed. <br /> C�. C�- <br /> NAME OF O«NER: u. ;�, S L�E� � PHONE: (home) %��� ` �73 -S�lJ <br /> (work) `l�1. `f 7S= �-' 3�c`�� <br /> �IAILING ADDRESS: �,C 1 i►f �/,��. /{.;��,��. !_.� CITY: �,,:.,�, L<-�, r ZIP: ;�5 3�S�- <br /> _ , <br /> CONTRACTOR: L. `� � L;�,,� >��� �,.�/ �.,, PHONE: 7�=3 4: �,5- �.��7 <br /> CONTACT PERSON: L ��I r�L s f�c� �IOBILE/PAGER i� �z- 'Z?Z - ��,�, .� <br /> NTAILING ADDRESS: L,'�c � �� r.�a �3� :�c CITY• :��� r a-�� � <br /> . . �'✓�.i ZIP: '�� 51_� <br /> STATE LICE�SE: # <br /> ARCHITECT/ENGINEER: PHONE: <br /> i�IAILING ADDRESS: CITY: ZIP: <br /> NA1�IE: REGISTRATION # <br /> TYPE OF�VORK: New Accessory Structure <br /> Addition Nlove <br /> RemodeUAIteration Land Alteration <br /> PROPOSED «'ORK (describe in detai�: �`�._;=�/��< < �� �- c i� --,�- (�.,, � ,-�-. ! �� �,� �?r F <br /> ��'f'z �i j ��`4c'�� t �� � <br /> STORIES: SQ. FEET OF E�CH FLOOR: <br /> NO. OF BEDROOIIS: GARAGE S�I'�I.LS: ATT. DET. <br /> ESTI`I_ATED CONSTRUCTIO\VALUATIO\ (excluding land): S / 3f h/�a � � <br /> I hereby apply for a buildina permit and I acl�o�rled�e �_at the information abo�-e is complete and accurate; that the <br /> work will be in conformance «-ith the ordinances and .odes of the City and wzth the State Building Code; that I <br /> understand this is not a permit and work is not to s•�rt�;=:.2out a pernut; and that the work will be in accordance with <br /> the approved plan. <br /> l,� � —�- �_'� <br /> APPLICANT'S SIG�'ATURE: � � ��ti�.� _:� �l:< DATE: / � � C��5 <br />