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ACTI¥1~' # <br /> <br />PLEASE FILL OUT THE FOLLOWING INFORMATION AND YOU WILL BE DIRECTED TO THE NEXT <br />AVAILABLE BUILDING CODE TECHNICIAN. ~,.~ <br /> 96-09-11 P02:21 OUT <br /> <br /> APPLICATION SUB/ IIAL <br /> <br />TYPE OF APPLICATION :~ <br /> <br /> WELLING [] BUILDING DEMOLITION [] MINOR EL LABEL <br /> [] DWELLING LABEL [] BITE PLAN REVIEW [] PLUMBING <br /> <br /> [] MANUFACTURED STORAGE [] SITE EVALUATION/SEPTIC\ [] DRIVEWAY <br /> <br />(~ NAME OF APPLICANT: ."'~. ~ y' L, '~]~LI~F...,,-~ <br /> ~ e.o~ln thewo, onro ~ <br /> : ~: regist~r:d builder or thPe a:~rliz::~e:r~:~:P~Y~ve of a registe.d bu,lder. State of Oregon Const~ion Contractors Board Registstion <br /> <br /> I am ~e autho~ed representative of ~e prope~ owner or cont~or. <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 />I certify that I have read this application and state that the information given is correct. I agree 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 />SIGNATUREinspecti°ns for this permit.oF APPLICANT: ~~~J~' <br />(_J.-:--? ? <br />FOR OFFICE USE ONLY: GEODISTRICT: FLOOD PLAIN=~...~SLID HIST, RIC.~ WETf-AND$ CAND USE CASE <br /> <br />SUeDIVI$1ON: LOT# eLOCK# <br />REV 6/19/96 <br /> <br /> <br />