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O FFICE US; ONLY 1 CITY OF AURORA BUILDING PERMIT Fo. OFFICE USE ONLY <br /> Applioatieo: , ~ /} ~. ,, 21420 Main St. ' PHONE .: Permit No~: ~~ <br /> Date: *__/~f ' / 97002 . FAX 678-2758 <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 PC :DA~E <br />1. Job Descri¢ion NRB DAT <br /> <br /> RESIDENTIAL' 'COMMERCIAL ~ New Use of Structure: <br /> O Addition r~ Relocation Q Addition r..3 Sign <br /> <br />[~ Alteration Ci Demctition r~ Alteration r~ Demolition Resident iai Dwelling, <br />, O A~esso~ ~her ~ Change o~ Oc~panoy . Q Other S i n g 1 e f a ~ i 1 y <br />Description of Work: NeW s~ngfe ~a~i~y residential ~onStructio~' <br />-~ss"~ orRafler~ ' ~ No,~orie$: I ~O~u~LoadorNum~rofEmployees: ~No. Bedroom$: 3 <br />Sq~a¢~"~eet~A~ent:,: -,,, -o~ , I Bainmoo~:, 2~024 ~ SecondFl'cor: -0-' } Garage: 506 ~ Height: 2 I' o~ <br /> <br />a] <br /> <br />2. I~oc~t,on of Installat:on <br /> Property Owner: sRK Constructioa,[ [nc. <br /> <br />Mailing Address: 5834 Flairstone Court SE Salemjk OR <br /> <br />· IPhone: (5(~"34 364'-328'~J <br />97306 <br /> <br />Job Address: 14670 Kasel Ct. NE ITaxAcct, No.: <br /> Aurora, OR 97002 SION0.: <br /> 2 Lot: 6 I Block: 2 <br /> <br />Subdivision: Kasel Ct., .Blk <br />SectiOn; J 3 Township: 4 $ <br />Lot Width: J Lot Depth: <br />Water Mster Size: <br /> <br />Range: <br />Acres: <br /> <br />Zone: R-i ' <br />Irreg, Lot::',; X X <br />LTyp~ ~'ack Flow: <br /> <br />Mapz~ l W 2 C Set Back: Front __ <br />Corner: Side.. _ Back__ <br /> <br />3, contractor InformatiOn, , .,. <br /> Proper~yOwner: .. SRK Conet'rUCt:.'io'ia IPhone: (503) 3,64-32.89 <br /> Mailing Address: L~.sted Above <br /> O I OWn, reside in, or will reside in the completed structure. <br /> ~ t understand that I moot register as a construction contractor if the struCture is sold or offered for sate before or upon completion. <br /> Q I w[ll be my own general contractor, <br />If I hire subcontraCtors, I will hire only subcontraCtors registered with the'ConstruCtion Contractor's Board. If J change my mind and do:hire a general contrscte% <br />,..contract with a contractor who is registered with the Construction C~tract0r's Board, and wilJ immed a ely nctfy City of Aurora of the name of he contractor <br /> Contractor E, usinessname&#; SRK Construction: COB #88317 IPhone: (503) 364-3289 <br /> MaJlJngAddress: 5834 Flairs~one Ct. SE Salem, OR. 97306 <br />~ [ am a registered builder OR the authorized repreaentat[ve of a registered builder. <br />Archit~efname: LM Brunier & Assoc. ~ Inc. <br /> <br /> Mailing Address: 1304 Si,/ Bertha t~lvd. Portland, OF, 97219 <br /> <br />4. Fee Schedule <br /> VALUATION (See "Valuation Schedule" to determine valuation based on square footage,) State Surcharge = 126.50 <br /> ~r~luation: $ I [ 3,89 O Plan Check '~=" 200 . 00 <br /> <br />System Dev. .--- <br /> 1,759.33 <br /> TOTAL = <br />Water Meter = <br />WAter Connection <br /> TOTAL <br /> <br />PermitlFee 733 · I 0 <br />Manufactured Home <br />Mechanical 50.60 -- <br />P(umbing 136.62. ~ _,,,1,327. O0 <br />Electrical 106.76 ],521. 18 <br /> <br /> RECEIPT: TOTALS = 3,28 <br /> <br />I hereby codify that the above information is correct and that I have read and understand the Information Notice to Property Owners about <br />Construction Responsibilities On the reverse side of this form, ~ <br /> <br />Signature of Applican~~ <br />DRIVEWAYS AND SIDEWALK INSPECTION ARE REQUIRED BY PUBLIC WORKS. <br /> <br />Date: <br /> <br /> <br />