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, CITY OF OR01�10 - BIIII,DING PERMIT APPLICATION <br /> Total Fee: $ Date Received: <br /> Date Approved: <br /> Entered By: <br /> Permit#: <br /> ALL INFORMATION IYIDST B$ SOBIKITTED II�1 FOI.L BBFORE PLAN RRVIEW i�ILL BE STARTED <br /> ---------------------------------------------------------------------------- <br /> TH$ APPLICANT IS: (circle one) OWNER or CONTRACTOR <br /> JOB SITS ADDRESS: //�-I� Nvi2TH Aiz✓YI ?JiZ� ZIP: ��3CO`'( <br /> (work) $�r - $�t�`f <br /> NAME OF OWNER: ��m �73;Z.o PHONE: (home) �/7�- y S 5� <br /> MAILING ADDRBSS:J/�-1� Ncu2 "/� �4�Z.vv� ]�jZ CITY: /'Yl d�� �•r� ZIP: S 5 3� `� <br /> CONTRACTOR: �c��`t G �2�� �'X c'RV A�� N G PHONE: �172 ' / 75 7 <br /> MAILING ADDRESS: YB�o V�� N�� �'�'�V�'�S �� CITY: i'1'lv���� ZIP: S53�y <br /> TYPE OF WORR: New Addition Accessory Structure MoveT_ <br /> Demo Remodel/Alteration Renovate Land Alteration�_ <br /> PROPOSED WORR (describe in detail) : T rhP,Zv�� �,2,�� ,uAc.� A��u Hs�. <br /> t-�w� A�� �_/l�'+`��'� (38.RnJ` <br /> STORIES:�_ SQ. FEET OF EACH FIAOR: Co�o � <br /> NO. OF BEDROO1rIS: Z GARAGE STALLS: ATT. DET.�_ <br /> :X <br /> SSTIMAT$D CONSTRDCTION VALIIATION (exclnding land) : $ So�p <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 Fermit 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 SIGNATORE: � DATE: �� /�'R� <br /> (Please fill out the reverse side of this form) <br />