|
FOI~FFICE USE,.~NLY ] CITY OF AURORA,BUILDING PERMIT
<br />Apptk;ation: I, 21420 Man'st ~:.X · ' ,PHONE: /PermitNe.:
<br /> .e~i~edey;"~~ Aurora.OR ,., ' .' r 678M283 :
<br />Date'. %-/¢¢)¢y '.:~' 97002, ..... FAX 6~8-2758 LDete: -
<br />COMPLETE ALL SECTIONS. 1 THROUGH 4 PC' ' 'N;I¢ DATE ,
<br />
<br />1. Job Description
<br />
<br />RESIDENTIAL
<br />~ Addition O,Reldcafier
<br />r-~ A~teration ~ Demoliben
<br />¢&t Accessory ~ Other
<br />
<br /> Description of Work: ~) ~
<br /> TrussQ or,Rafter~_..j Ne. Stories:
<br /> Square Feel;: Basement;
<br />
<br />2,_L_ocation-.of ,Installation .., ........ %.. .
<br />
<br /> MailingAddross.:. /~2/,~/)" %.~,,~. ~ om]
<br /> Job Address'. ,/~,~/._,,.%~ -~ ,,~_¢~ ~ ~, ~ /~ ~::2._.'.
<br />
<br /> Section: 'j Townsdip; '1 Range:
<br /> Lot Wdth,, "~7'~ o~ .?-~l 'Let DSpth'. /~-/ ,..~ I Acres'.
<br /> Water Mete- Size:
<br />
<br />3. ,Contractor InfOrmation
<br />
<br /> HRB BAT
<br /> COMMERCIAL El New I Us~ of Strueture:
<br /> r~ Addition" ~ $ig~l I '
<br /> F~ Alteration G Demolition
<br /> r~ Change of Occupan~,~ CI Other
<br /> '..
<br /> ~ ~J, , occu.~ant boadi~.~umber of Employees:. ,
<br />I Main FlOOr: 7_,~e~con..q~ Fcloer: I Garage: ~¢/~¢,,~/ J Height;
<br />
<br /> I Phone:
<br />
<br />Tax Acct. No.:
<br />
<br />Site No,:
<br />
<br />Zone: Map: Set Back:' Front
<br />Irreg. Lot; Corner: S de Back
<br />Type Back Flow:
<br />
<br /> Mailing Address'
<br /> Q own tbs de n, or w~ res de n t~e Como eted structure ,,,, '
<br />
<br /> Q I understand that I ~us~ regieter as a construct on con,tamer f the structure is sold or offered for sale before or uoon come,eicon.
<br /> Q w 'be my own gener~ ~ntramor /~ , ~, , " -'"
<br /> If I h~re subcontractors, I will h~re only subcontr~tor~eg~stere~wlth the ~gnstruction Contm~o~ s Board. I I ch'ang~ my m nd and do h re a genera contra~o w
<br /> contra~ with a contractor who is regist?ed with the'Conmructid~ ~~nd will i~diately noti~ City o( Aurora of the name of the co'triter
<br /> Co~tm~or Bus ness name &
<br />
<br /> I~m.a reg~s[ere~'builder OR the aethorized'~pre~entetigeof a registered' bu der.
<br />Architem.name: ~ I phone:
<br />~,ng Address: .
<br />
<br />4."Fee Schedule
<br />
<br />VALUATION (See Valuation Schedule" to determine valuation based on souare footage.) State Surcharge
<br /> Valuad0n: $ ~2.~- ~ * ~ Plan Check
<br />~ermit Fee ~- ~ Syszem Der,
<br />Manufactured Home .,-- TOTAL
<br />Mechanical 5~' 4/~ Ware- Meter
<br />Plumbing / ._5" ?~_~_ Water Connection
<br />Electrical ~ ~.,.~ , ;~,~- TOTAL
<br /> RECEIPT: ¢'~ ~'
<br />
<br />TOTALS
<br />
<br />I hereby certify that the above information is correct and that I have read and understand the information Notice to Property Owners about
<br />Construction Reseonsibilities on the reverse side of this form.
<br />
<br />-/710
<br />
<br />
<br />
|