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FQ. OF IC£ O,,Y CITY OF AURORA BUILDING PERMIT I FOR OFFICE USE ONLY <br /> Application: ~'~~],4 21420 Main St. PHONE /Permit No.: ,.~._% 3 <br /> Received By: .~__U~7~4~ Aurora, OR 678-1283 [ By:jIL ~ <br /> Date_~¢~,.; / ~ 97002 FAX 678-2758 ~ Oate;~ <br /> <br /> BUILDING PERMIT APPLICATION <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 PC DATE <br />1. Job Description HRB DAT <br /> <br />RESIDENTIAL <br />Addition :3 Relocation <br />Alteration f3 Demolition <br /> <br />COMMERCIAL [] New <br />Fj Addition ~1 Sign <br />F~ Alteration r~ Demolition <br />i} Change of Occupancy Q Other <br /> <br />Useof Structure: , <br /> <br />Descriptio.~ Work: <br /> <br />Truss!Q/ or Rafter:-~ J No, Stories: <br />Square Feet: Basement: <br /> <br /> Location of Installation <br />Property Owner: <br /> <br />Mailing Address: <br />Job Address; <br /> <br /> ~ I Occupant Load or Number of Employees: [ NO, Bedrooms: <br />I ~F ocr: ~..~_Z.,,¢-~ Second Floor:/~.~.~ "Garage: ~"~ ~::~..,~;~1'~ Height: :~.~.~'" <br /> <br />Tax Acct. No.: <br /> <br />Bite No.: <br /> <br />Subdivision: Lot: <br />Section: Map: <br /> Acres; Irreg. Lot: Corner: <br /> <br />Water M6 Size; Type Back Flow: <br /> <br />I Block: <br /> Set Back: Front ~"(~ <br /> Bide -~,..-(~)__ Back <br /> <br />3. Contractor Information <br /> <br />Property Owner: -~¢¢~ ~ IPhone: ~¢~¢~-.~-' __ I <br />Mailing Address: <br /> <br />· F~, reside in, or will reside in the completed structure. <br />r.3 I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon csmpletlen. <br />:~own general contractor. <br />If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractor's Board. If I change my mind and do hire a general contractor, I will <br />contract wifh a contractor who is registered with the Con?tuction Contractor's Board, and wil]4~lmediate, Jv notify City of Aurora of the name of the contractor. <br /> ..... <br />Contractor Business name & #: ~- [ ~-~(¢:~(//~'~tU one: <br /> <br />Maih'ng AddresS:, ~(~ <br /> <br />131 am a registered builder OR the authorized representative of a registered builder. <br />Architect name: ~"~._~%.; <br />Mailing Address: <br /> <br />4. Fee Schedule <br /> <br />VALUATION (See "Valuation Schedule tO determ ne valuer on based on square foe age.) <br /> <br />Permit Fee = ~'~ ~.. ~ ~_ <br />Manufactured Home = <br />Mechanical = ¢_~._. j.._~__ <br /> <br />State Surcharge <br /> <br />P~an Check <br /> <br />Syetem Dev. <br /> TOTAL <br />Water Meter <br /> <br />Plumbing : ~o ~...¢_ Water Cennectlen : 13 ~ .7. <br /> <br /> [2~ ¢, ¢7 ¢~ECEIPT:~ [~, Q TOTALS ='~O-51. <br />I hereby ceAi~ that the above information is corra~ and that I have read rn~ understand the Information Notice to PropeAy Owners about <br />Coestruction Responsibilities on the reverse sMe of this form. <br /> <br />Name a, App,icant (Please~t); ~~~e.~ ~ ~..... Phone: ~7~ ~ <br />Signatu re of Appllcant;~~~_~ ......... Da,e: Z--Z~/ <br />DRIVEWAYS AND SIDEWALK INSP~T~ON ARE REQUIRED BY PUBLIC WORKS. <br /> <br /> <br />