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' 5 <br /> 3 <br /> Total Fee: $ J' Date Received: <br /> E.ter:d By: f ermit#• &1,01,3 -d6 3 <br /> CITY OF OROIY - BUILDING PERMIT APPLICATION <br /> Ali information must be submitted in full before plat; review will be started. <br /> (please print all information) <br /> THE APPLICANT IS: (circle one) OWNER ORONTRACTOR l <br /> JOB SITE ADDRESS: isd ZIP: <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? <br /> [:] Yes PH�90 If yes,a special event permit is required with Police Department and City Council approval <br /> 60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates <br /> sufficient on-site parking is available. Non permitted events will not be allowed <br /> NAME OF OWNER: 1-)Ayltc d 5v-e. Qukezl; PHONE: (home) rj z -173 <br /> (work) <br /> MAILING ADDRESS: f 4)aa�-h t2WqM &I CITY: ZIP:E2 <br /> CONTRACTOR: ryr PHONE: �J®3 <br /> CONTACT PERSON: fy -06y MOBILE/ R:r,,,tZ- C'!,0- Wiz. <br /> MAILING ADDRESS: VJ1A - CITY:L-9- ZIP: ZJ <br /> STATE LICENSE: # 7Wt) EXPIRATION DATE: 3-31-J <br /> ARCHITECT/ENGINEER: PHONE: <br /> MAILING ADDRESS: CITY: ZIP: <br /> NAME: REGISTRATION: # <br /> TYPE OF WORK: New Addition Accessory Structure <br /> Move Home emodel/ Iteration <br /> PROPOSED WORK(describe in detail): Q4jl d <br /> STORIES: SQ.FEET OF EACH FLOOR: <br /> NO.OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED <br /> ESTIMATED CONSTRUCTION VALUATION(excluding land): $ 11 j X 6 <br /> I hereby apply for a building permit and I acknowledge that the infonnation above is complete and accurate: <br /> ,hat the work will be in conformance withthe ordinances and codes of the Cite and with the Stag Building <br /> ode;that I understand this is not a pen-nit and•Vvork is not to start without a permit;and that the woJk-will be <br /> in accordance with the approved plan. <br /> APPLICANT'S SIGNATURE: DATE: <br /> 3 <br />