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CITY OF OR0�0 � 6122494616 O�I�7J0� 15:5� � :0�l02 N0:596
<br /> � �" To�l Fea: S `�I S 58 T1ate Reccived: �"' C�-�
<br /> Ente�ed By: � Penalt�: - -��a(0 3_S
<br /> CI`TY Q�' t7�R4N0 - BLTI7,,]pIN� �'��IT APPL�CA1"�C1N
<br /> All #nform�tloa must be �ubmitted in fi�l bePore glan rre�riew �rill lae st�rted.
<br /> (p�os�s print a11 informatton)
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<br /> TY�� AP�'LI�AIti"T IS: (c�rcte ant) 0'4VNER �1Ei'.C4N`I"�.ACTt)�2. : . ;'-� �, I �
<br /> JOB SI'� ADDRESS: �`� .� �'..' � s � � ��. ;,� �`� e L , 2�"a � . ' �_�
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<br /> NA,ME O�' t�VV't�T��t: �r'�I�t. I�� �c' (�'����u�ti^� PH+C3NT: (t�vme} _ �.� '-=��-� )�--
<br /> (work) .
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<br /> I1���L1[NG A.DD�t+F�5: `��.%``�� E'i����t i� �'r" C�'TYi r,.�; :�'�` r t i s ZYP: _`-> > `_�_��r
<br /> ca�cro�: ' �.��;��� t.�' - :� ��<<�; ,�� �xar�: "J s� `�-c <<�� y�,�c.�
<br /> Cl�le1'I'ACT P1�RSClN: ��!' :��l t ��„►t : �QBII,E/PA���t: ; .��` -. '>�' - � !5 � .
<br /> fA�1'�' +�v�w�n�r ,r;s-_ .., .
<br /> �'�••o����R^-�a: �5 . 9 �"+ `.�3!C �� Yi '�� ,i �.�r' .�!�:�r'�r,.,''.Pi,�,,y'1. ,Zr�: .5 ..:� ��J .
<br /> S"t"A�"�'E L�CFN�t # �- n. �' �-_� � �1 � }-
<br /> ARC�C'T/E�G]NEER: r`�"�'�` PT�OY�:
<br /> 1��IAILING ADDRES"�: CITY: Z�P:
<br /> NA.�LE; REGTST�tA"I'ION#
<br /> T"YPE t)►� '�YO1�.K: Ncw Ad�i�on Acce9sory Structur��
<br /> Move � Ramodel�Al�eratiaa �-��� Lan�Alt�ration�
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<br /> PR.�►�'U5E3J►'4'V4R�(de,�crtb��n daraiTj: �`:a'r� p� �-��"I�,a-� � Ct w= 1�� ��
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<br /> � ) c� � ��� r �.s..•��„� � � '� _", v-�rT, t :7,,,,,�,,,C�{ 4�-� � ..��� �v-�t,� t.: � t'C � 1 i �' ��
<br /> � � tiL {�:.� t ('�\:ir��lh ���l `, t J I
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<br /> xo�o sE�axoon�s: ��������►���a�i.�s�A��~r. z� ��T �. ;�;F , �.. ,:�,��_�
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<br /> EST�L�iTF:D CONS'I"Ti.�C'Y"YQ�"VALUA`�'t�Y(e�cc�uding lan�: � �-�t:i�'" f , r
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<br /> I k�ereby�pgt�' for a building ptrmit and Y actimowled�e tl�.t rhe i�.fot�caatioa abovtyis c�mpleta and '���"`"�' t�
<br /> ac�ur�te; �hat the work wi11 be in cor�f'ormaace with the ordiva.nces �r.d codes af thc Ciry aad w�
<br /> � the 5tatc Bui�Eding �oc3c; that i uadtrstaxtd t�is is avt � permit and work ls not to start wfthout �
<br /> ptt�ct,it; a,za,d that tt�e work wiIl be in Accordaacc wi[h tt�e a�proved pl�n.
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<br /> AFPLICAN'1'�S SiG�IAT'[TRE: �.�;',�;jz i`,v. `•� � �°-� {^ DATEs r. �, � �..�, -
<br /> NpT"�l Parade of]�'ornes tveRts requ�r� saparata permit approval by Police Departrnent artd
<br /> Cfty Caunctl 60 days priar to the event. Non perm�tted events wt?!not be allowed.
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