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ACTIVITY # <br /> <br />PLI~ASE FILL OUT THE FOLLOWING INFORMATION AND YOU WILL BE DIRECTED TO THE NEXT <br />AVAILABLE BUILDING CODE TECHNICIAN. <br /> <br />TYPE OF,, APPLICATION <br /> LDING ~ ~ AG EXEMPT BUILDING ~ ~ ELECTRICAL <br /> DWELLING [ ~ BUILDING DEMOLITION I ~ MINOR 6L LABEL <br /> <br /> ~ i DWELLING LABEL ~ ~ SITE PLAN REVIEW PLUMBING <br /> ~ ~ MANUFACTURED DWEI. L[NG I ~ $[TE EVALUAT[ON ; I MECHANICAL <br /> <br /> ~ ~ MANUFACTURED STORAGE r ~ SITE EVALUATION/SEPTIC ~ DRIVEWAY <br /> ~ ~ PRE.FAB ~ ~ SEPTIC ~ INFORMATION <br /> <br />NAME OF APPLICANT: G /p?dAk .H# ¢/I ? <br /> <br />PROJECT ADDRESS: ~.O~-~'p.,.. L~.L--,f--?..%...7~'/~..~ ~'~.~ ,, <br /> <br />WORK DESCRIPTION: <br /> <br /> I am performin8 the work on prope~y I own or occupy. <br /> <br /> I ama registered builder or the authorized representative of a re§istered builder. ~ ~'" <br /> State of Oregon Construction Contractor's Board Registration # . <br /> FAX# <br /> - , <br /> I am the authorized representative of t~e prope~ owner or contrac~~ <br /> <br /> ' wilJ be hirin8 a 8enera, contractor reBistered with the Construction Contractors ~r~. <br /> ~ 6 995 ' <br /> <br />This application may 80 throuBh a simultaneous review process where zonin~'Se~ (d applica~ and <br />construction requirements are checked prior to issuance of a permit. It is the responsibiliW of the applicant <br />to ~ssure that ~1( necess~W 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 />FOR OFF1GE LL.e~ ONLY: <br /> <br />CROB, S STRICT: <br /> <br />LOT# <br /> <br />REV 8/3FJ5 <br /> <br />TAX ACer, '7q"7 ~ 0" ~ [O <br /> <br /> <br />