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Total Fee: $ • 113 Date Received: /9 0 tot 2 3 r <br /> Entered Dy : L,I Permit#: 3/ 2- I/70 <br /> - <br /> CITY OF OR S NO - BUILDING PERMIT APPLICATION <br /> All information must be submitted in full before plan review will be started. <br /> (please print all information) <br /> THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR <br /> — <br /> JOB SITE ADDRESS: 2:--- O 04E- 10 ZIP: <br /> NAME OF OWNER: /22/ice- /1) PHONE: (home) <br /> (work) <br /> MAILING ADDRESS: CITY: ZIP: <br /> CONTRACTOR: 1 a.,J OrAu,eF, PHONE: <br /> CONTACT PERSON: MOBILE/PAGER: <br /> MAILING ADDRESS: '3s-15' vCTy ,/vr, CITY: 50,4-77/ %,rij ZIP: 5-51.7:1. — <br /> STATE LICENSE: # <br /> ARCHITECT/ENGINEER: PHONE: <br /> MAILING ADDRESS: CITY: ZIP: <br /> NAME: REGISTRATION# <br /> TYPE OF WORK: New N. Addition Accessory Structure <br /> Move Remodel/Alteration Land Alteration <br /> PROPOSED WORK(describe in detail): /G <br /> STORIES: SQ.FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. <br /> ESTIMATED CONSTRUCTION VALUATION (excluding land): $ <br /> 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 /> 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 win be in accordance with the approved plan. <br /> APPLICANT'S SIGNATURE: ;;, %? DATE: 3-,25-- O,) <br /> NOTE! Parade of Homes events require separate permit approval by Police Department and <br /> City Council 60 days prior to the event. Non permitted events will not be allowed. <br /> 5 <br />