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FF;C; US; O,LY 1 CITY OF AURORA BUILDING PERMIT <br /> APO'kid!ion: ~-~ ~'--f~--- I-. 21420 Main St. PHONE <br /> R~'.e~ ,ed e¢~ Aurora, OR 678-1283 <br /> o~,~e: ~_.~' ~ 97002 FAX 678-2758 <br /> BUILDING PER~IT APPLICATION <br /> COMPLETE ALL SECTIONS, 1 THROUGH 4 PC _~/~ DATE <br /> <br />~ ~[' COMMERCIAL ~ New t Use ef Stature: <br />, 2 Addiflen Q Relocation Q Additlen QSign <br /> <br />~ ~ A~te~'atio~ ',2 Demo~itlon ~3 AIteratio~ ~ Demolition ~ <br />k__~_~.~?ssory ~Other Q Change of Occupancy ~ Other <br />' Sascript~on of Work: <br /> <br />FOR OFFICE USE ONLY <br /> ; <br /> <br />Truss .2 or Rafter~l I No. Stories: <br />Square Feet: Basement: <br /> <br />Location of Installation <br /> <br /> No Bedrooms' <br /> / IOccupant L°ad °r Number °f Emp~°yees: I' <br />I Main Floor; I Sec°nd Fi°°r:~J~¢~ P l Garage: /2/z/,¢.~ I Height:, <br /> <br />,!ob Address; <br /> <br />./<'A ~¢:/- <br />Towr ship; l Range; <br />Lot [Depth: ~ ~ <br /> <br />Section: <br /> <br />Let Width; <br /> <br />Water Meter Size: <br /> <br />Zone: Map: <br />Irreg. Lot: Corner: <br /> <br />Type Back Flow: <br /> <br />tSet Beck; Front ....... <br /> Side Beck <br /> <br />Contractor information <br /> <br />'~rope~yOwner: 5 /~ /"'f. ~,. 1PhOne: <br /> <br />Mailing Address; <br /> <br />b ! own. reside in, or will reside in the COmpleted structure, <br /> <br />~ I understand thet I must register as a construCtion contractor if the structure ia sold or offered for said before or upon completion. <br />~ I will be my own generel contraCtor, <br />!f' hire subcontractors, I will hire only subcontractors registered with the Construction Contractor's Board. if I change my mind end do hire a general contractor, I will <br />contract with a contractor who is registered with the Construcfion Contractor's Board, and will immediately notify City of Aurore of the name of the contractor. <br /> <br />~I am a registered builder OR the euthorized representative of a registered builder. <br /> <br /> Architect name: ~_.L~ut/ /~_/~ <br /> Mailing Address: / _~ / ~- /~ ~ 3-.~ <br />4. ~ee Schedule <br /> <br />VALUATION (See "Valuation Schedule" to determine valuation based on square footage.) State Surcharge <br /> Valuation: $ __ Plan Check <br />Permit Fee _ ?,~ ./~ System Bev, <br />Manufactured Home TOTAL <br />Mechanical ~ ~, ~ ~ Water Meter <br /> <br />E'ec:rical I .1~ TOTAL <br /> <br />RECEIPT: <br /> <br />TOTAL $ ; 3 .~; ~_.~,. 3'..%. <br /> <br />r~ereoy certify that the above information is correct~a.qc~hat I have read and understand the Information Notice to Property Owners about <br />Co'-.'.;',ructJon Responsibilities on the reverse s~f~J~.orm, <br /> <br /> re sr Applicant (P ease Print)' // ~_~ ~ ~ ~ Phone'~ ~-~%¢~ <br /> <br />D~[',/EWAYS AN~ SIDEWALK INSPECTION ARE REQUIRED BY PUBLI~ WORKS. <br /> <br /> <br />