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ACTIVITY # <br /> <br />~, '~UT THE FOLLOWING INFORMATION AND YOU WILL BE DIRECTED TO THE NEXT <br /> _ s ,x,x <br /> <br />APPLICATION SUBMITTAL <br /> <br />Type OF APPLICATION <br /> [] BUILDING [] AG EXEMPT BUILDING [] ELECTRICAL <br /> <br />/~ MANUFACTURED DWELLING [] SITE EVALUATION [] MECHANICAL <br />[] MANUFACTURED STORAGE [] SITE EVALUATION;SEPTIC [] DRIVEWAy <br />[] PRE-FAB [] SEPTIC [] INFORMATION <br /> <br />NAME OF APPLICANT: ~"7-'~ <br /> <br />WORK DESCRIPTION: <br /> <br /> ) I am performing the work on pmperiy I own 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 # G'~ 5'~1 <br />FAX# <br /> <br />) I am the authorized representative of the property owner or contractor. <br /> <br /> ) I will be hidng a general contractor registered with the Construction Contractors Board. <br />~" ~/)~'- "-~r~/~s~d revl r ss erez nih <br /> This application may go tougn a s' ultaneous 'ew p oce wh o ' g, septic (if applicable) and <br /> construction requirements am checked prior to issuance of a permit. It is the responsibility of the applicant <br /> to assure that ail necassa~y information has been provided. <br /> As soon as all requirem;nts of the review have been met, you will be notifi~ has~en <br /> issued and ready to be picked up. (~,.~ .,~.2',~'-,~ ~ / <br /> I certify that I have read this application and state that the information gw'v-~'/r-'-r.,~,ea:act~'r~gree to <br /> comply with all state laws and county ordinances relating to building construction. I will authorize <br /> a representative of Building Inspection to enter on the property for the purpose of making <br /> inspections for this permit. <br /> <br />SIGNATURE OF APPLICANT: <br /> <br /> <br />