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ACTIVITY # <br /> <br />PLEASE FILL OUT THE FOLLOWING INFORMATION AND YOU WILL BE DIRECTED TO THE NEXT <br />AVA, LA.E ,U,LD,NG CO 'E TEC"N'C'AN. ipg _f3 l <br /> <br /> APPLICATION SUBMITTAL <br /> <br />TYPE OF APPLICATIDN <br />[ ~ BUILDING ~ AG EXEMPT BUILDING <br /> DWELLING [ I BUILDING DEMOLITION <br /> <br /> L~ DWELLING LABEL t,, ~ SITE PLAN REVIEW <br /> h ~ MANUFACTURED DWELLING ~ .. · SITE EVALUATION <br /> <br /> ~ I MANUFACTURED STORAGE ~ ~ SITE EVALUATION/SEPTIC <br /> ~ PRE-FAB ~EPTiC <br /> <br />NAME OF APPLICANT: <br /> <br />ELECTRICAL <br />MINOR EL LABEL <br />PLUMBING <br />MECHANICAL <br />DRIVEWAY <br /> <br />PROJEC~ ADDRESS <br /> <br />WORK DESCRIPTION: <br /> <br />( ) <br /> <br />( ) <br /> <br />I am performing the work on property I owe or occupy, <br /> <br />I am a registered builder or the authorized representative of a registered builder. <br />State of Oregon Construction Contractor's Board Registration # <br />F^X# <br /> <br />I am the authorized representative of the property owr~er or contractor, <br /> <br />I will be hiring a general contractor registered with the Construction Contractors Board, <br /> <br />This application may go through a simultaneous review process where zoning, septic (if applicable) and <br />construction requirements are checked prior to issuance of a permit. It is the responsibility of the applicant <br />to assure that all necessary information has been provided, <br /> <br />AS soon as all requirements of the review have been met, you will be notified that your permit has been <br />issued and ready to be picked up, <br /> <br />SIGNATURE OF APPLICANT: <br /> <br />FOR OFFICE USE OILY: <br /> <br />zoo~ caess Sl'r,~: , [ ~,~A _ _ / ACCr £ <br /> LO/# BLOCI~ <br /> <br />REV 5116195 <br /> <br /> <br />