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FOR OFFICE USE ,ONLY'' i CITY OFAURORA BUILDING PERMIT FOR OFFICE USE ONLY <br />Appcatlon.~t ~ ;/'i [ , 21'420 Main St ' , : PHONE <br />Received ~y;J/L~ 'l~,~.<'~'='~¢j Aurora. OR' ,, ' ,, 678 1283 .... , <br /> <br /> BUILDING pERMIT APPLICATION <br /> <br />.COMPLETE ALL SECTIONS, 1 THROUGH <br />1. JOb Description <br /> <br />PC .......... DATE <br />HRB DAT <br /> <br />Addition O Relocation Q Addition · · r3 Sign <br />Q Alteration El Demolition ~1 AlteratiOn , n Demolition ResideaCial Res. <br /> <br /> Accessory m. Other Cl Change of OccuF~ncy ~n Other ....... <br /> <br />09¢cdption of Work: S. F. R, <br />Tms~ orR~fterC~,, No, Stories; 2 I OecupantLoadorNumberofEmptoyees; ............ 1Nc. Bedrooms: 3 <br />SquareFest: Basement; --- I Main~ber: ~o~ 7. I 76~+$36 ) Height: <br /> <br />2. LocatiOn of Installation <br /> PropartyOcmer: 5'c. of. & CarolTn <br />Mait[agAddress: ~3u~ ~ ~w <br /> .JO6 Address: ) ~-068. 2nd,,,,,S~. <br /> Aurora~ <br /> Subdivision: <br /> s~n,, i] -- Township: 4 8 ~ge: <br /> Lot Width: ./' [,¢~ Depth: <br /> <br />~eJnin~e <br />u~ Wilsomville, .... ~ 97070 <br /> <br />Water Meter Size: . <br /> <br />IW <br /> <br />3. Contracto~ informati~. <br /> Property Owner: Sco~ & Carolyn'He~'nge <br /> MaillngAddre$~ Sates as above <br /> <br />~£own, reside in, or will reside in {he comp eted stm~Ure. <br /> <br />Tax Acct. No.: <br />S~e No~! <br /> <br />(503)"'094-56'67 <br /> <br /> ILot: 9ol 604 50 Block: 5 <br />Zone: RJI Map: ]W 12C~ SetBad~: Front <br />,r~eg:i,Let: ..COmer: ' ak:is SaCk_. <br /> <br />Phone: (503) <br /> <br />694-5667 <br /> <br /> Qliunderstandthat mustregisteraea~nstruclloocontmctor f the structure is SO d, orofferedforsalebeforeoruponcompleton <br /> rS I: will be my own general esntractor. <br /> //'/hirs ¢,ubcontract~rs, I w~ll hire on~' subconfraemrs registered with the Constr~tion COntractor's Board. I( I change my mind a~d do hire a general contractor <br /> contract wi~h a contractor who i$ regL~tered with the C'or~!~O¢ Contractor's Board, and will immediate~/notify City of Aut0r~ of the name of the contractor. <br />ContmmerBu$ines~name&#: 57082 Heininge Const:ruction JPhone: (~'03) 694-5667 <br />-~a~lll"~gAddress: a5055 SW Curry Dr, W~l's°nVil%e, OR · g~070 <br />o t~em a registered builder OR fhe authorized represer~tative of a registered build'ri' ' · · <br />Archlte~namg;._S__unreI Pi. an ¢2218g 811~t~hville IPhane: 1~800~.547-5570 <br /> MaillngAddre$~: PO Box 50670 ~innaapoli$~ "~ 55405 <br /> <br />4. Fee Schedule <br /> <br />VALUAT{ON (See -Valuation Schedule" to determine value, on based on square footage.} ~te ~r~e = 5 6.6 7 <br /> Valuation: $ _J~.~, 0 8 2" P~n Che~ 2 00. O 0 <br />Permit Fee = 823 · 89 System ~v. -- ~ 75 <br />Manufa~ured Home = __.. TOTAL 1 , 8 I 6.2 l <br />Mechanical ~ W~r Meter ~ 60.00 <br />Plumbing ~ 53.4 [ ' Water ~n~ection <br />E~emr,u~i I I 9.67 TOTAL =~.:~ <br /> TOTAL . <br /> <br />RECEIPT: 2 3 9 0 <br /> <br />hereby certify that the above information is correCt and that I h~ read and underatand the Informatior~ NOti~;e tO Properly Owners about <br />Construct/on Respons;bilitle¢ on the reverse side of ~hle form. <br />Name ofAppilca~/ (Please Print): ,~J ~(~,~ !i{,3i ~k3C~ <br /> <br /> <br />