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PLEASE FILL OUT THE FOLLOWING INFORMATION AND YOU WILL BE DIRECTED TO THE NEXT <br /> <br />AVAILABLE BUILDING CODE TECHNICIAN. <br /> <br />APPLICATION SUBMITTAL <br /> <br /> TYPE OF APPLICATION <br /> <br />~ BUILDING [] AG EXEMPT BUILDING <br />[] DWELLING [] BUILDING DEMOLmON <br />[] DWELLING LABEL [] BI71; PLAN REVIEW <br />[] MANUFACTURED DWELLING [] SITE EVALUATION <br />[] MA~UFACTUREU STOP, AGE [] S,TE EVALUATION/SEPTIC <br />[] PRE-FAB [] SEPTIC <br /> <br />[] ELECTRICAL .~ <br />[] MINOR EL LABEL <br />[] PLUMBING <br />[] MECHANICAL <br /> <br />[] DRIVEWAY <br />[] INFORMATION <br /> <br />NAME OF APPLICANT; <br /> <br />PROJECT ADDRESS; <br /> <br />WORK DESCRIPTION; <br /> <br />I am a registered builder or the authorized representative of a registered builder. ~)0~ ~_~'~ ~ <br />State of Oregon Construction Contractor's Board Registration # <br />FAX# <br />lam the authorized representative of the property owner or contractor. ~,~ i t {~[~'Y'~ <br />I will be hiring a general contractor registered with the Construction Contractors Boar~'~ ~ <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 previded. SOI <br />As soon as all requirements of the review have been mat, 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 />inspections for this permit. /7 <br />SIGN ATU RE OF APPLICANT · ,~f_/~//~ -~ <br /> <br />FOR OFFICE USE ONLY: GEODISTRICT: FLOOD PLAIN <br /> <br />MAP PAGE: ZONE:__ CROSS STREET: <br />SUBDI¥1SION: <br /> <br />SLIDE HISTORIC.~ WETLANDS <br /> <br /> LAND USE CASE <br />TA~ ACC~4 <br /> <br /> BLOCK# <br /> <br />LOT# <br /> <br /> <br />