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to. O Fm; UsE ONLY 1 CITY OF AURORA BUILDING PERMIT
<br />Application:~.-r%=~_~'~._~__ j ' ~ 21420 Main St . PHONE
<br />Rec,e. ived By; ~~~L) Aurora, OR ' ' ~ 678-1283
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<br />FOR OFFICE U.$E 0."Y
<br />Permit NO.:
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<br /> BUILDING PERMIT APPLICATION
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<br />COMPLETE ALL SECTIONS, 1 THROUGH 4 PC ~k~/k
<br />1. Job Description HRB~ ~(~
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<br /> RESIDENTIAL ' COMMERCIAL ,~1 New I Use of Structure:
<br /> '-~ Addition Ci Relocation O Addition O Sign I .~¢ '~.~fl/c /"~"
<br /> 3 Aftermion Q Demolition J O Alteration 0 DemolitiOn
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<br /> ~Accessory ~Other ~¢~ (~+~.~Change of Occupancy ~Other
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<br />~3~ or Raher :3 Ne; Stodest ~ ' Oc ' L ' '¢ ....... ]' No. Bedr~ms;
<br />Square Fee~ Baseme*t: ~/~ ~MaJn Foot: /'0~'~ I Second FIO?,: ///Z, I aarage: y~ ,,
<br />2. Location of Inslallatio.
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<br /> Job Address: /V / 45 ~X~ ~/ r T~x Acct. No.:
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<br /> Subdivision: -- ' ' I Lot; ~. Block:
<br /> Semion: ~ ~Township: ~ I Range: l~8~} JZone: ~-j ~Map:~l¢l~SetBack:'Front~'O'
<br /> L%t Wd~:/¢~'~ Lot Depth: ~,'~ // }'Acres:~¢., / ~ j lrreg, Lot: - Comer': q side
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<br /> water Meter Size: ~ // ~Type Back Fbw:
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<br />3. Contractor IDformation
<br /> Property OWner: ~p,~,/,<..,, ,.~'~'~',~.~ . ,,~., ~. ~-~ ~,,~../~ .~ ~Pho~e; ~b~-~'~- ~ ~ ~
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<br /> 3 } own, reside in, or will reside in the completed stru~ure.
<br /> ~l understand tha~ I must register aS a oons~ru~ion contractor ff the structure is sold or gffered for sale before or upon ~mp~¢ion.
<br /> } t wiJl be my own genera( contractor,
<br />if I hire subcontractOrSr i will hire only subcontractors registered with the Oonstru~ion Contra~or's Board, If I ¢hange my mind and do hire a genem~ contra~or, I will
<br />~ registered with the Construction Contra¢or's Board, and will immedie[e~.notJ~ Ci~ of Aurora of the name of the con[racier,
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<br />~1 am a registered builder OR the authorized representative of a registered builder.
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<br />4. Fee Schedule
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<br />VALUATION (See "Valuation Schedule" to determine valuation baaed on square footage.)
<br /> Valuation: $ { / ~5'//, ~ ¥
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<br />Permit Fee = ",7 ~,~ o ¢~</
<br />Manufactured Home =
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<br />Mechanical ~2, ~ ~
<br />Plumbing =-'/'~.R,~ ,,~-'~
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<br />syatem Dee, 6', 7
<br /> - 173 C
<br />Water Meter = ~ ~ 3 '~
<br />WaterOonnection = 13'~7, ~
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<br /> RECEIPT: ~>,'~ ¢ -- TOTAL
<br />O0~strucdo~ Respo~sib,lltles on ,h~everse s,d. of this ,orm.I hereby ce.,fy that the above ,nformation.~¢~i$ corre~ ~-~.a"d that I have.~ ~..readx- *~* - ~., *'¢~and u~derstand the Information~¢¢ Notice to Prope~
<br />Name of Applicant (Please Print): .~~,~~. ~,,. ~ -- Phone:
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<br />Sigaature o~ Appl~cant:~.. Oa~:
<br />DRIVEWAYS AND SIDEWALK INSPECTION ARE BEQUIRED BY PUBLIC WORKS,
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