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'FOR OF!=~¢EfJSE'ONLY <br />..... CiTY OF AURORA BUILDING PERMIT I FOR OFFICEUSE ONLY <br /> :...:,. :~21420 Main St. PHONE ,:. ,~ ] Permit No.: ~ ~/- / ~ __ <br />/ Recei~B~~ Aurora, OR Ap~~, , <br /> BUILDING PERMIT <br /> <br />COMPLETE ALL SECTIONS, ~ THROUGH 4 PC <br /> <br />1. Job Description <br /> <br />HRB <br /> <br />RESIDENTIAL COMMEROIAL <br /> Addition r3 Relocation Li Addition <br /> [..I Alteration <br /> Q Change of Occupancy <br /> <br /> rj Alteration CI Demolition <br /> r3 Accessory ,[~ Other <br /> ....Description of Work'. ~¢'6//'/~ /[../¢..//~ //Y/e IJ~ <br /> Truss r2 or Ra*er~ { No. Stories: ~ [ O~upan[ Load or Number of Employees: / <br />....~" Feet'. Basement'. ~ Main Floor', ~0~ 3 Second Floor:'~/~. Garage'. <br /> <br /> MARION CCbJ~'Y <br />QNowI~UILujNb Ilbl[f~l~cture', Ac~ff/~6¢¢¢ -E- <br /> Sign <br /> <br /> Demolition <br /> Other . <br /> <br />No, Bedrooms: <br /> <br />Height: <br /> <br />Subdivision' ~¢..4~ (~,O&4' <br />Section: I ~ Township: ~S Range: / ~ Zone; ~- I Map: <br />~ot W dth: Lot ~epth: Acres: ~ ~ Irreg. Lot: .J Corner: <br />Water Meter Size: Type Ba~ FI~; <br /> <br /> phone: <br /> <br />Tax Ac~. No,: . ~0 177 - I 0 <br /> <br />LOt: /~ ~ BI0ck: <br /> <br />Set Sack: Front <br />S de Back <br /> <br />3. Contractor Information <br />Property Owner, [~ I ~f--- ~ I/~ ~ ~' ~ ~"Jr~ Plflone' · ~ $ 0 :~ (. -~Z~ ~ <br /> <br />/I~1 own, reside in, or will reside id the completed stru~ure. <br /> Q understand that must register as a constru~ on contractor f the stru~ure s so d or offered for sale before or upon comp etlon. <br /> <br /> F~ I will be my own general contractor. . .:.. L¢:~ <br /> If I hire subcontractors, r will hire onl) <br /> contract with a contractor who <br /> Contractor Business name & #: <br /> Mailing Address: ~'./-.,¢..¢..~ 0 <br /> am a registered builder OR the authorized representative of a registered builder. <br /> Architect name: (?o,_ A./ ' ,~/~, ,/~C <br /> <br />4, Fee Scheaule <br /> VALUATION,:(See "Valuation Schedule" to determine valuatibn b~ed on square footage,) <br /> ~luation: $ , [ I ?~ ? ~ ?, <br /> <br /> If I change my mind and do hire e general contractor, <br />end Wi[[ immediately net[~/City of Aurora of the name of the COntractor, <br /> <br /> System Dev. <br /> TOTAL <br />MeChanical = .5 (~, ;J ~ Water Meter ._~ <br />Plumbing = ~./~51, ~.¢' ~ Water ConneXion <br />~e~rical = / 1 ~, I &_ TOTAL <br /> ~¢.,.~ RECEIPT: TOTALS <br /> <br />Permit Fee <br />Manufactured Home <br /> <br />hereby certify that the above information is correct and that r have read and understaqd the Information Notice to Property Owners about <br />Construction Responsibilities on the reverse side of this form. <br /> <br />Name ot Applicant (Please Print): _..~J (L/-f/~.., I,,..~, .CD''~ I/¢~/~ ~//¢0 I--~ <br />DRIVEWAYS AN~ SIDEWALK INSPECTION ARE REQUIRED BY PUBLIO WORKS. <br /> <br />State Surcharge <br />Plan Oheck <br /> <br /> <br />