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BUILD - 1466678
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BUILD - 1466678
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Last modified
2/1/2013 1:38:04 PM
Creation date
8/9/2004 2:23:24 PM
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Permits
Permit Address
21390 MAIN ST NE
Permit City
Aurora
Permit Number
555-96-07976
Parcel Number
041W13BA05600
Permit Type
BUILD
Permit Site Number
Aurora Rural FD
Permit Doc Type
Permit Document
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0~-0~'96 12:40P CITY OF AURORA <br /> <br />503-678-2758 <br /> <br />P.O! <br /> <br />FOR omcE O. LY ] CITY OF AURORA BUILDING PERMIT <br />Appfication: . ,, ~_ . Il 21420 Main St, PHONE <br />t Received By~'~'~L~J Aurora, OR 678-1283 <br /> <br />COMPLETE ALL SECTIONS. 1 THROUGH 4 PC DATE ' ,. <br /> <br />1. Job De$©rlption <br />~IDENTtAL <br /> ,~rAddltion Ij Relocation <br /> :J Alteration ~J Demolition <br /> ~ Accesson/ J Other <br /> Description of Work: <br /> <br /> HRB <br /> COMMERCIAL <br /> ~ A~lition [~ New <br /> U Sign <br />~ Alteratior~ [.J Demolition <br />I ..:.,} Change of OCCUl~ncy O Other <br /> <br />DAT <br />use c~tf{b INSPECTION <br /> <br /> Truse~ or Rafler~.~" I No. Stories: <br />"'~'~uam Feet: 8asem';~'~t: ,~ <br />2. Leeatlea ef Insallaion <br /> <br /> Su~iv~ion: <br /> S~tion: 1~ . 'T~wnshiD: ~ I Range: I ~ <br /> <br /> Water Meter Size: <br /> <br /> I ' I Occupant Load or Number o! Em~oyees; ' I No. Bedr~ms: <br />IMain~°°r: ~O~3 J SocondFIoor: '~- I Garage: ~ I Height: <br /> <br />C~)~.' ¢ O? <br /> fTo <br /> <br /> Site .No.: ....... <br /> Lot: I Block: <br /> <br /> Ty~ B~ Flow: .................. <br /> <br />3. Contractor Information <br /> <br />.~ I own, raside in, or will reside in t~ ~mp~t~ stature. <br />'J I understa~ that I must r~ist~ as a ~nst~ion ~ntraclor if the stru~ure is ~ld or offer~ for sale ~fore or u~ completion. <br />~will be my own general ~ntra~r. <br />If I hire ~on~r~ors. I ~11 hire only su~ntr~ r~istered ~th the Consbu~n Contra~r's ~ard. II I c~ange my m~nd ar~ do ~m a general conira~or. I ~11 <br />contm~ with a c~ntmctor who i5 r~isler~ wi~ ~e Co~Iruc~on Con[r~or's Board, a~ will i~.~e~a~ no~ Ci~ of Aurora of the name ot the ~ntmclor. <br /> ~traaor B~Jness ~me & ~: I Phone: <br /> Mailing Address: <br /> '~ I am a r~isler~ b~er OR Ihe aulhoriz~ represen~We of a registered builder. <br /> <br /> Mniling Address: <br /> <br />4, Fee ~ohedule <br /> VALUATION (See "Valuation Schedule" to determine valuation based on square footage.) <br /> Valuation: $ <br /> <br />RECEIPT: <br /> <br />State Surcharge <br />Plan Check <br />System Dev. <br /> <br /> TOTAL <br />Water Meter <br />Water Connection <br /> TOTAL <br /> TOTAL <br /> <br />~ermit Fee <br />Manulaclured Home <br />Meal~a,ical <br />Plult~bing = <br />Flec~rical = ._. <br /> <br />! Ive~uby c'ertiiy tha. t the above information is correcl a~ that I have read and undersland the Information Notice to Proc, erly Owners about <br />C',Orr'~tn.~ction Responsibilities on the reverse side of this form. <br />Name of Appticam (Ple=se Print):r~lr.{'E,5 . ./~ .Phone: ...~.~' <br /> <br /> <br />
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