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� CITY OF ORbNO -'BDILDING PERMIT APPLICATION <br /> Total Fee: $ (�/ 7-� �-� Date Received: �'��o ' c1� <br /> Date Approved: <br /> Entered By: ,�,a� <br /> Permit�: �QJ`�- <br /> AT•T• INFORMATION MDST BS SIIBMITTED IN FIILL BEFORE PLAN RRVIEW WILL BB STARTED <br /> (See Check-off List Enclosed) <br /> -------------------------------------------------------------------------------- <br /> THE APPLICANT IS: (circle one) OWNER or CONTRACTOR <br /> JOB SITE ADDRRSS: <br /> � � ZIP: S S.a,S�',� <br /> (work) <br /> NArII; OF OWNER: ,5�� V� �Ul�Yl � 'E' iC- PHONE: (home) �}'`I/�-$6�� <br /> MAILING ADDRESS: 6 `t�j �..��24'0-�.�'1.� ���� CITY: ��a�a 7i1 ZIP:S'-S� 3�6 <br /> CONTRACTOR: �2.� �+�'�t,p0� �:..(.r/6 , PHONE: �`� �' -- g'1� '� <br /> MAILING ADDRESS: !, D, ✓B� I'3� CITY: �, Z d�_x � ZIP: ,,r.��Q 1 <br /> , � <br /> STATE LICENSE: � U db 4 3 og <br /> ARCHITECT/ENGINEER: i�\! �� , PHONE: <br /> MAILING ADDRESS: CITY: ZIP: <br /> NAME: REGISZ�2ATION # <br /> TYPE OF WORR: New Addition� Accessory Structure Move <br /> Demo Remodel/Alteration Renovate Land Alteration <br /> PROPOSED WORR (describe in detail) : � 1 �� <br /> STORIES:_�_ SQ. FEST OF EACH FLOOR: j� 8 _ <br /> NO. OF BBDROOMS:�_ GARAGE STALLS: ATT.�� DET. <br /> ESTIMATED CONSTROCTION VALIIATION (eacluding land) : $� !7 p 6� ' <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 approved plan. � <br /> APPLICANT'S SIGNATURE: �l�/�'�� ''3`"LQ�`Y��. DATE: �'1�"'�I �- � _ <br />