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ACTIVITY#. ~ _ <br />PLF~kSE FILL OUT THE FOLLOWING INEORMATION AND YOU WILL BE DIRECTED TO THE NEXT <br />AVAILABLE BUILDING CODE TECHNICIAN. <br /> <br />APPLICATION SUBMITTAL <br /> <br />.~f?E OF APPLICATION <br /> <br />NAME OF APPLICANT: <br />PROJECT ADDRESS: <br /> <br />AG EXEMPT BUILDING [] E[.ECTRICAL <br />BUILDING OEMOLI~ON J~] MINOR EL LABEL <br />SITE PLAN REVIEW [~] PLUMBING <br />SITE ~ALUA~ON ~ MECHANICAL <br />SITE ~ALUA~ONISEPTIC ~ ORIV~AY <br /> <br />WORK DESCRIPTION: <br /> <br />( ) <br /> <br />() <br /> <br />() <br /> <br />I am pedorming bhe work on property I own or occupy. <br /> <br />I am a registered builder or the authorized representalJve of a registered builder. <br />State of Oregon Construction ContJ-actor's Board RegislratJon #/~/.-~ ~:¥.'Z..~.. <br /> <br />I am the authorb:ed representative of the properly owner or contractor. <br /> <br />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 pdor to issuance of a pen-niL It is ~he responsibility of the applicant <br />to assure that all necessarf information has been provided. <br /> <br />As soon as all requirements of the review have been me[, you wile be flotJfied thai 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 />compty 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 />FOR OFFICE USE ONLY: GEO01S )~Jcr: F[.O00 pLAJN SUOE__ IYIS TORIC__ WIz-n. ANO$__ ~JVD USE C~sE__ <br /> <br /> <br />