Laserfiche WebLink
Total Fee: $ 3 / Date Received: 140 5a 3� <br /> Entered By: Permit #: <br /> CITY OF OR NO - BUILDING PERMIT APPLICATION <br /> All information must be submitted in full before plan review will be started. <br /> (please print all information) <br /> ------------------------------------------------------------ --------------------------------------------------------=----------------------- <br /> THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR <br /> ZIP: <br /> JOB SITE ADDRESS: 77"C� ro — l l) �'v <br /> NAME OF OWNER: (�� ���,� PHONE: <br /> (work) <br /> MAILING ADDRESS: ��g�2�- q� / CITY: 14 ZIP: _5 <br /> CONTRACTOR: �a �� /�p c� PHONE: <br /> CONTACT PERSON: 7 -:j;avL17Ej�)e-),,J MOBILE/PAGER: !jZ Pte,cz 7 / <br /> MAILING ADDRESS: j4,-<:?(2 r, ter,G(Ce ,,r ITY: ZIP: <br /> STATE LICENSE: # <br /> ARCHITECT/ENGINEER: L ti PHONE: 3 <br /> MAILING ADDRESS: irq CITY: jj�?L-S ZIP: <br /> NAME: E4 `�LW, 5 REGISTRATION# <br /> TYPE OF WORK: New—X Addition Accessory Structure <br /> Move Remodel/Alteration Land Alteration <br /> 1 <br /> PROPOSED WORK(describe in detail): <br /> � ,��TACl-iE17 �•-f o P�4C�� �'���'� <br /> STORIES: SQ.FEET OF EACH FLOOR: ZtG - �' 02 7 z <br /> p NO. OF BEDROOMS: GARAGE STALLS: ATT. ;�-7 D .__�3 <br /> �f) ESTIMATED CONSTRUCTION VALUATION(excluding land): $ _7! <br /> Ln L <br /> -S �° I hereby apply for a building permit and I acknowledge that the information above is complete and <br /> accurate; that the work will be in conformance with the ordinances and codes of the City and with <br /> i the State Building Code; that I�understand this is not a permit and work is not to start without a <br /> permit; and that the work will;be in accordance with the roved plan. <br /> APPLICANT'S SIGNATURE:",�,� DATE: S Z g <br /> NOTE! Parade of Homes eventsite separate permit approval by Police Department and <br /> City Council 60 days prior to the event. Non permitted events will not be allowed. <br /> 9 <br />