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ACTIVITY # <br /> <br />PLEASE FILL OUT THE FOLLOWING INFORMATION AND YOU WILL BE DIRECTED TO THE NEXT <br />AVAILABLE BUILDING CODE TECHNICIAN. <br /> <br />APPLICATION SUBMITTAL <br /> <br />TYPE OF APPLICATION <br /> SU LDING AG EMPT SU LO NG ELECTRICAL <br /> [] DWELLING [] BUILDING DEMOLITION [] MINOR EL LABEL <br /> [] DWELLING LABEL [] SITE PLAN REVIEW [] PLUMBING <br /> [] MANUFACTURED DWELLING [] SITE EVALUATION [] MECHANICAL <br /> [] MANUFACTURED STORAGE [] SITE EVALUATION/SEPTIC [] DRIVEWAY <br /> [] PRE-FAB [] SEPTIC [] INFORMATION <br /> <br />NAME OF APPLICANT; -..-~ _ '<=:~-~/'--., PH# ~ -~;~_~,.. <br /> <br />WORK DESCRIPTION: , ~. t ' <br /> <br />( ) I am performing the work on property I own or occupy. <br /> <br />( --)~am a registered builder or the authorized representative of a registered builder. <br /> State of Oregon Construction Contractor's Board Registration # ~' . <br /> <br />( ) I am the authorized representative of the property owner 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 />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 Inspe/etto~ to enter on the property for the purpose of making <br />inspections for this permit. ~/ ~ 2. <br />SIGNATURE OF APPLICANT: ~ <br />FOR OFFICE USE ONLY: GEODISTRICT: FLOOD PLAIN~ SUDE.~ HISTORIC~ WETLANDS___ LAND USE CASE <br /> <br />MAP PAGE: ZONE: -- CROSS STREET: TA~ ACCT# <br /> <br />SUBDMSION: LOT# BLOCK# <br /> <br /> <br />