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� Y Y <br /> CITY OF ORC'•IO - BUII�DI�TG FER�`�LZT APPLIC�,TION <br /> ,� ,.._.� . <br />�tal. Fee: $ � Date Received: /� f� 2.-� <br /> , Dat� ApD?^OV2d: , <br /> tered Bv: � Pe�ait�: `�� 9� - � _ . <br />,,;; INFORMATION MIIST BE SIIBMITTED IN FULL BEFORE PI�N R:��7IEW WILI+ BE STARTED <br /> (See Check-Qrf Li st Encl.osed) <br />�`AppLICANT IS: (circl.e one) OW:�1ER or CONT'LtACTOR <br /> . SITE ADDR$SS: ��� O /`�'� ����_ ��� . ZIP: ' ��S 3 'J�� <br /> (work) �/n�-'1Z/� <br /> ,� OF OWNER- � c�, L a � ��J �1 PHDNE: (home) ��" `1!G� <br />�II,ING ADDRESS: ���D � ��c�c. \\J✓�.__ CITY: �u o ZIP: �J���_ <br /> °dTRACTCR: �C I 1 PH{?NE: <br /> .;I�IPTG ADDRESS: ��✓?v'C�-� CITY: ZIP: <br />�Z`E LIC_.�NSE: ,'ir <br /> �:HITECT/ENGINEER: PHONE: <br /> _I.ING ADDRESS: CITY: � ZIP: <br /> �_ REGISTR.ATSON � <br />��E OF Tr+ORK: New Addition Accessc���ructure riove_� <br /> _ D�o Remodel/A1.teration Renovate Land Alterati.on <br /> � � <br /> "', -f� 2G1 l,'�/o P <br /> flB�SED WORR (descri.be i.n detail) : � � � <br /> C �� <br /> \1 � C�e�I��/1.S .7 � � �� �� � C' c�v1//S � <br /> _ ,o <br /> 7RIES:�_ S4- �T OF EACH FI�OOR: . <br />_ pF BEDROOMS:� C�RAGE STALLS: ATT.�_ DE'='. <br /> TTl�tATED CONSTRIICTSON VAI�IIATION (egcluding Iand) : 5 <br /> hereby appl.y for a building permit and I ac?cncw�edge that the information <br />„ve is complete and accurate; that the work wi11 be in conforinance with the <br /> dinances and codes of the City and with the S�ate Building Code; that I <br /> 3erstand this is not a erm t and work is not tc start without a permit; and <br />�t the work will be ' accor ance with h a proved pl.an. • <br /> LICI�NT'S SIGNATURE: <br /> DATE s l D � 3 �(.� ,. <br />