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FOR OFFICE USE ONLY
<br />Appflcption;
<br />
<br />Rock,iv '!d By: ...............
<br />
<br />Date:
<br />
<br />COMP! FTE ALL. SECTIONS, 1 THROUGH 4
<br />1. ,lob Description
<br />
<br />CITY OF AURORA BUiLDtN
<br /> · 21420 Main St,, PHONE
<br /> · Aurora,,OR 678-1283
<br /> 97002 FAX 678-2758
<br /> BUILDING PERMIT APPLICATION
<br />
<br /> HR~'-'
<br />
<br /> RESIDENTIAL
<br /> rJ Addition [J Relocation
<br /> !J Alteration [J Demolition
<br />
<br /> ',,J Accessory
<br /> Description of Work;
<br />
<br /> or Rafter ~l No. Stories:
<br /> Feet: Basement:
<br />
<br />2, Location.of Installation
<br /> Property Owner:
<br /> Malting Address;
<br />
<br /> Job Address:
<br />
<br />COMMERCIAL m New
<br />CI Addition iq Sign
<br />rZI Alteration iq Demotition
<br />Fn Change of Occupancy L~ Other
<br />
<br />Use of Structu[~.~kj 5 '~ 199:!.
<br />
<br /> UARION OOUNt't
<br /> BUILDING INSPECTION
<br />
<br />Occupant Load or Number of Employees:
<br />
<br />Main FIoor:-~,C if?~. I Second Floor:
<br />
<br />No. Bedrooms:
<br />I Height:
<br />
<br />}Phone:
<br />
<br />Tax Acer, No.:
<br />
<br />Site No.:
<br />
<br />SubdJvi,';ion: r Brock:
<br />Section: i'Z.-- Township: Range: j ~ Zone: ,,tiC.,, f I Map; '~/¢L~ /~-" SetBack: Front
<br />Lot Width: Let 0epth: Acres: Irreg. Let: ~ Corner: S de Back
<br />Water Meter Size: Type Back Flow:
<br />
<br />3. Contractor Information
<br />Property Owner: D~,I~'~- P,¢4 ¢'~,~hr'SC'J*(~;:'~ ...... IPh°ne:
<br /> ~3 1 own, reside in, or w~ll reside in the c~mpleted structure~ '
<br /> Q ~ understand that I must register as a ~nstru~ion ~ntractor if the stru~ure is sold or offered for sale before or upon completion,
<br />~will be my own general contra~or,
<br /> ire su~ontractors, I wilt hire only su~ontractors registered with the Constru~ion Contractor's Board, If I change my mind and do hire a general ~ntracter, I will
<br /> contract with a contractor who is registered with the ConstruCen Contractor's Board, and will immediately noti~ City of Aurora of the name ol the ~ntra~er.
<br /> Contra~orBusinessname&~: ~ I. ( ~ (~ ~~ ~Phone; '~-~
<br /> M~il~ng Address; , , . :..: ,
<br />
<br /> O I am a registered builder OR the authorized representative of a registered builder,
<br /> Architect name: I Phone:
<br /> Mailing Address: ', , : ....
<br />
<br />4. Fee Schedule
<br />
<br />VAI t JATION (See "Valuation Schedule" to determine valuation based on square footage,)
<br />
<br /> Va hl,:~tiom $ ...........
<br />Permit Fee
<br />Manufactured Home
<br />Mechanical
<br />Plumbing
<br />Electrical
<br />
<br />RECEIPT;
<br />
<br />S~ate Surcharge = . ._._..~,~'~..l~ ....
<br />Plan Check = _..~._~_~?
<br />System Dev, ~,'"',.~-~ E~ ~
<br /> TOTAL /= /'.~f~'~,, .1Z'
<br />Water Meter ~ ~, ~, q,~
<br />Water ConneXion _~ ~, ~ ~ 0
<br /> TOTAL ~ ~ W~
<br /> TOTAL $ = ~.~
<br />
<br />[ hereby oedlfy that the above information ls 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 />Signature of Date: /o
<br />
<br />
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