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FF CE USE ONLY CITY OF AURORA BUILDING PERMIT I FOR OFFICE USE ONLY <br /> A pplic at b n: ' ~,~--,,,~0- .............. I . 21420 MAin SL 'PHONE Permlt No.: <br /> Receiv. ed.. [~y: ~'(~ ~ ~'r~ Aurora, OR 678-1283 By :_,~.'.,._~...~.. <br /> <br /> BUILDING PERDIT APPLICATION <br />COMPLETE ALL SECTIONS. 1 THROUGH 4 PO DATE~ <br />1, Job Description HRB DA~ <br />RESIDENTIAL : OOMMEBOIAL Q New Use of Str~ur~;:~ <br /> J Addition Q Relocotion' ~ Additio~ ~ Sign <br /> ¢2 Atteration Q Demo~tion ~ Alteration Q Demolition <br /> ~ Accessory ~Other Q Change of O~upancy ~ Other <br /> Destination of Work: /~ ~ ~/ ~ ~ ~ /. <br />-'Tr~ss4 or~a~er~ I No, Stories: / I Oc~u~ntLoadorNumberofEmployees: ~No. Bed~om*: <br /> SaMara Feet: ;Basement: I Main Floor: a I ~ 6~ Second Floor: I Garage: ~ ~ ~ I Height:- ?~..~_~ <br />2. Location of installation <br /> Propedy Owner; /~ ~/~ ~ ~--~ ,, ~z. ( . <br /> Job Address: / A/'¢ ~ ~ ~( ¢ ~ ~ / I Tax A~. NO.: <br /> % . ..... <br /> <br />Sec?ion: I Township: Range: <br />Lot Width: Lot'Depth ' Acres: <br />Water Meter Size: ~ ' ' <br /> <br />3. COntractor IMormation <br />Property Owner: ~' ~'.d.,L,~.. <br />I M~iling Address; <br /> <br />Type Back Flow: <br /> <br /> Site No, " <br />IL°t: IB'°°k: ~ <br />Zone: ~"~-i Map: ~ 60 Set Back: Front <br />Irreg: Lot: Corner: Side "~ 'Back <br /> <br />I Phone; .... <br /> <br /> own. reside in, or will reside in the completed structure.'" <br /> I <br /> g@derstand that I muet r~tg star as a co-lstruct on contractor f the stru .lure s so d or offered for sa e before or ur, on compleson. <br /> will be my own gener"cj contractor, <br /> hire subcontractor-*, f will hire on,, suocon[ractors regmrerea with the Construction Contractor's Board, If I change my mind and do hire a general contractor <br /> contra~ct with a contractor who is reg~s~e, reo wl~r the Construction Contractor'~ Boarc. And will immediately notify City of Aurora of the name of the contrsctor, <br /> 0ntr~ct0rB0sinessname&#: I,~-'Z'-/~J /~/~.~ I ~"~c_, ._~-¢-/~.."7~ IPhone: <br /> <br /> aC a registered builder OB the authorized rep~entativ~ of a rag stered bu der ' <br /> <br />~ailidg Address: ; z'~ : ' <br /> <br />Will <br /> <br />4. Fee Schedule ...................... <br />VALUATION (See *'Valuation Schedule" to determine valua~lo~.~_ed On aquore footage.) <br /> Valuation:$ i ,~ z./~ .~__ , <br /> <br />State Surcharge .... ~ <br />Plan Check .__ ~ ¢~> <br /> <br />Permit Fee ? ¢~ System Dev. <br />Manufaclured Home ~ __.,.,, ~J~ TOTAL -~ <br />Mecharacal ~ i ~ Water Meter <br />Plumbing . ,~ ,.~ ~ Water Connector = <br />Ele~d~l I ~ ~ TOTAL = <br /> BECEIPT: __ TOTALS.- <br /> <br />nereey certify that the above infor~nation s correct and tha~ I have read and understand the Information Notice to Proper~y Owners about <br />Construction Re..oonsibilities on the reveme side of this form ". <br /> <br />Signature of Applicant; <br /> <br />DRIVEWAYS AND SIDEWALK INSPECTION ARE REQUIRED BY PUBLIC WORKS. <br /> <br /> <br />