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FOR OFFICE USEONLY '1 CITY OF AUROp BUILDING PERMIT [FOR OFFICE USE ONLY <br /> Application."'%. l ,[I. / , 21420 Main St. , PHONE ~.t.F~e,.rmi!~a:: <br /> Receive~dE~y:Y~ /'~"lP/(,~.~--"'~"~/ Aurora, OR . 6784283 JBy~' <br /> Date:~[~ lev / j 97002 FAX 678-2758 <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS 1 THROUGH 4 PC DATE <br />~, Job Descri~io. HRB DAT <br /> <br />RESIDENTIAL COMMERCIAL r~ New Use of Structure: <br />n Addition FJ Relocation Q Addition Fj Sign <br />FJ Alteration n Demolition CI Alteration CI Demolition Residential Res, <br />L3 Accessory r~ Other r~ Change of Occupancy r~ Other <br />Description of Work: S. F. R. <br />Truss,'[K orRaffarO I N0. St0ries; 2 I OcsupantLoadorNumberofEmployeas: ...................... I No. Bedrooms: 3 <br />square Feet: B~ement: --- I MainFIoor: ~o~ I SeoondF,oor: 774 I Garage: 768+$36 I Height: <br /> <br />2. Locat,on of installation <br /> <br />P~partyOwner: scoT,_ & Carolyn Heininge <br />Mailing Address: 8505 ~ ~w ~Url~J D~'~., Wil$onville, OR <br /> IobAddress: 15068 2n~.~.S~f. NE ~ <br /> Aurora, OR [S, teNo:~ _, <br /> <br /> IPhone: ( 503 ) <br />g7070 <br /> <br />604 5o <br /> <br />694-5667 <br /> <br />Subdivision: <br />Section: I 2 Township: 4 $ Bange: <br />Lot Width: , Lot Depth: Acres: <br /> <br /> Irreg. Lot; <br />1 'Type Back F ow: <br /> <br />Map: 4]WI2CD <br /> <br />Corner: <br /> <br />Set Back: Front <br />Side Back ......... <br /> <br />Water Meter Size: · <br />3, Contractor Information <br />Pr0pertyOwner: Scot & Ca~olyn'Hein£nge IPhone: (503) 694-5667 <br />Mailing Address: ~ame as above <br /> <br />l~i~[own, reside in, or will reside in f~he completed structure. <br />r-, Ii understand that ! must register as a construction contractor if the structure is sel~ or offered for sale before or upon completion. <br />CJ I; will be my own general contractor. <br />Itl hire subcontractors, I will hire only subcontractors registered with the Con,ruction Contractor's Board. If I change my mind and do hire a general contractor, I will <br />contract with a contractor who is registered with the C'onstruction Contractor's Board, and will immediately notify City of Aurora of the name cf the contractor. <br /> <br />Contractor Business name & #; 57082 }{eininge Construction <br />Mffll%ngAddress: 8505B SW Curry Dr. Wil$o~ille, OR <br /> <br />IPhone: (503) 694-5667 <br /> <br />9~070 <br /> <br /> ~ tlam a registered builder OR the authorized representative of a registered builder. <br /> ArchiteCtnam_e..;._ ~untel Plan ¢22189 Sal~rhville IPhone: 1-800~547-5570 <br /> MaillngAddress; PO Box 50670 ~linneapoli$, ~iN 55405 <br /> <br />4. Fee Schedule <br />VALUATION (,See "Valuation Schedule".to determine valuation based on square footage.) State Surcharge -- .56.67 <br />Valuation: $ ._.1108,082' Plan Check ~ 200.00 <br />823,89 System Dev. = ~ <br />.... 56. S/ TOTAL ~ J , 8 I 6.2 J <br /> Water Meter = 660.00 <br />[ 5 3 · 4 I Water Connection <br />119.67 TOTAL <br />RECEIPT: 2 3 9 0 <br /> <br />Permit Fee <br />Manufactured Home <br />Mechanical <br /> <br />Plumbing <br />Electrical <br /> <br /> =_~ 660.00_ <br />TOTAL $ : ~7,6/2~I. <br /> <br />I hereby certify that the above information is correct and that I have read and understand the Information Notice to Properly Owners about <br />Construction ResponsibJJities on the reverse side of this farm. <br /> <br />Name 0f Appllcant (Please Print): <br /> <br />Signature of Applican,:~.,~7"' · 3 G~_ _ .~?,~. <br />DRIVEWAYS AND SIDEWALK INSPECTION ~E~UIRED B~BLIC WORKS <br /> <br /> <br />