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fRFOR OFt4CE USE ONLY / CITY OF AURORA BUILDING PERMIT I FOR OFFICE USE ONLY
<br /> ~p~ic¢~cn:)/~_/_/~....__~.)~('~.Y~ 21420 Main St. PHONE [ Permit N.o.: ~'¢,/~ ~'
<br /> eceived By: .......x-,,,-¢ ..... ~ Aurora, OR 678-1283 ay: .2¢.¢~.~ ¢
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<br /> BUiLDiNG PERMIT APPLICATION
<br />COMPLETE ALL SECTIONS, 1 THROUGH 4 PC DATE ~,,/ ~1 /"~'
<br />1. Job Description HRB DAT
<br /> RESIDENTIAL COMMERCIAL ~ New Uae of Structure:
<br /> BI Addition Q Relocation BI Addition [~ Sign
<br /> L3 AKeration F~ Demolition LI Alteration BI Demolition
<br /> i-~ Accessory ~Other Q Change of Occupancy CI Other
<br /> Description of Work: ~J .~.~, ~./
<br /> Truss BI or Rafter,~J.
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<br />2, Location o! Installation
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<br />Prope y Owner:
<br />Mailing Addrees:
<br />Job Address:
<br /> Site No.: I...,,¢;,"1~ ~
<br />Subdivision: I Block:
<br />Section: ~ownship:' Range: Zone: Map: Set Back: Front
<br />
<br />Lot Width: Let Del~th; Acres: [r[eg, Lot: Corner: S de Back
<br />Water Meter Size:
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<br />No.:
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<br />3. Contractor:infOrmation
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<br /> ~oWn, reside in, or will re~ide in the completed stru~ure.
<br /> ~1 understand that I must register as a constru~ion contra~or if ~he s~ru~ure is sold or offered for sale befo~ or upon completion.
<br /> ~1 will be my own general contra~or,
<br /> If I hire subcontra~oB, I will hire only subcontra~ors registered with the Con,ruction Contractor's Bea~, If I change my mind and do hire a general ¢octracter, I will
<br /> contract with ~ contra~or who is registered with the Const~ion Contractor's Boa~, and will immediately ncti~ Ci~ of Aurora of ~he name of [he coptractor.
<br /> Contm~or Business name & ¢: %/,'A ¢- R,A:;~-~O , J Phone: ¢'Y ';¢;.* · %( '~"~
<br /> Mailing Address; _ .¢~ .j~;~ Z/~< ~2~: ~. ~/~ ~ , '¢:;¢~%
<br /> ~ am a registere¢ builder OR the authorized representative of a registered builder,
<br /> ~ ...... ?'% '- ~' ' ~Phone: (].::.") <],.:]) - %[ ""~
<br /> Mailing Address: /~.~',, ,,.~ ~,:>,
<br />4. Fee Schedule
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<br />VALuATIoN (See "Valuation SchedSe" to determine valuation based on square footage.)
<br />
<br />Manufactured Home
<br />Mechanical ? ,~, ~ ;2
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<br />State Surcharge
<br />Plan Check
<br />Sy~,~m Dev,
<br /> TOTAL
<br />Water Meter
<br />Water C0nnecti0n
<br /> TOTAL
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<br />RECEIPT: __&~_a~ ...... TOTAL $ = ~b~_J~_~__~_~-
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<br />I hereby certify that the above information is correct and that I have read and undemtand the Information Notice to Property Owners about
<br />Construction Responsibilities on the reverse side of ti)is farm.
<br />Name Of Applicant (Please Print): /'"~ / i'//~ .~' ',,,~¢~ Phone: __
<br />Signature of Applicant: ._.~:¢~.%...~_ 2 ,',~ ~ ~ .., ./,r .r Date:
<br />DRIVEWAYS AND SIDEWALK,II~'SPEcTION'--- AR~ REQUIRED 8{' ~UBLIC WORKS,
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