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~OR ~FFI¢,,~ USE ONLY I CITY OF AURORA BUILDING PERMIT I FOR OFFIC,.E USE ONLY <br />Application;--h~-'.-,,,: ,;;,';;'u~ ,° 21420 Main St. I~ ~ ~ ~r~:: ¢(~-I~ ....... <br />Received ~y: ~~ Aurora, OR ' ~ ~ /~:~ ........ <br />ga,t.:...~¢ 97002 FA~8-2758, "~ a..~?t~"e¢- <br /> BUILD NG PERBIT APPLICATION~'IA~: ~' ~¢,~ <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. -itoh [~e$criptlon <br /> <br />PC <br /> <br />HRB <br /> <br />Relocation <br /> <br />RESIDENTIAL <br />rj Addition <br /> <br />COMMERCIAL <br /> <br />LJ Addition <br />~Atteration <br />L] Change of Occupaecy <br /> <br />Alteration [J Demolition <br />Accessory i.J Other <br /> <br /> Oescription of Work: .,¢~o ~.,I,¢;~ ~.~'//"-/,~ ~ ,~.-,.-,~¢ <br /> TrussrJ or RafterIJ I No. Stories: ~ I Occupant Load or Number of Employees: ~ O I NO. Bedrooms: <br />Square Feet; Basement: I Main Floor: '~.11 (~ I Second Floor; ~r I ~, I Garage: t Height: <br />2, Location of Insl~Jllntion <br /> <br />Property Owner: <br /> <br />Mailing Address: <br /> <br />Job Address: <br /> <br /> ........ l Phone: ~ ~ - <br /> <br />Ls Ta, A~t. No.: ~ ~O <br /> itc NO.: <br />JL~t~ I Block: <br /> M p: I Set <br /> Corner: ~ 0 Side <br /> <br />Subdivision: <br /> <br />Section: 1 ~ I Township: ~/ ~_% Range: <br />LotWidth: ~..~-/.~ j Lot Depth: ~O00 Acres: <br /> <br /> Zone: <br /> Irreg. Lot: ~ <br /> Water Meter Size: Type Back F ow: <br /> <br />3. Contractor Information' <br />Property Owner: I Phone: <br />Mailing Address: <br /> <br />Back <br /> <br /> I..I I Own, reside in, or will reside in the completed structure. <br /> <br /> Li I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. <br /> tj I will be my own general contractor. <br /> If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractor's Board. If I change my mind and do hire a generaI contractor, I will <br /> contract with a contractor who is registered with the Construction Contractor's Beard, and will immediately notify City of Aurora of the name of the contraCtor. <br /> <br /> Mailing Address' /~,~' -%', ~¢'4d~/~.."/ ' ' ' ~ - -' ~/¢~' ¢,~,,~.~ ~4 7~7/ <br /> ~1 am a registered builder OR the authorized repre~en~tive of a registered builder. <br /> Archite~name; ~/~ ~ ~A&~ ~Phone; g ~ ~ - [ g ~ ~ <br />Mailing Address: L I ~ [ ~ ? ~ ~ ~ [ ~ ~ E~ <br />4. ~ee Schedule <br /> <br />VALUATION (See !'Valuation Schedule".to determine valuation based dn square footage.) <br /> Valuation: $ ~- ¢! ~ 0 0 <br />Permit Fee I..~/~..~..~'~ <br />Manufactured Home <br />Mechanical <br />Plumbing = _ ................... <br />Electrical <br /> <br />State Surcharge <br /> <br />Plan Check <br />System Dev. <br /> <br /> TOTAL <br />Water Meter <br /> <br />Water Connection <br /> <br /> TOTAL <br /> TOTAL <br /> <br />RECEIPT: <br /> <br />I h~'roby 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 />Name of Applicant (Please Print): ¢~'~_,~, ,//2~-~1~! ¢:' ~2,,~-s 7~' <br />Signature of Applicon: -~. ~ <br />DRIVEWAYS AND SIDEWALK INSPECTION ARE REQUIRED BY PUBLIC WORKS. <br /> <br />Phone: ~ ~]- tJ_~'.7 ......... <br />Date: %-~/-?~ <br /> <br /> <br />