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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 />[] BUILDING [] AG EXEMPT BUILDING [] ELECTRICAL <br />[] D1/VELLING [] BUILDING DEMOLITION [] MINOR EL LABEl. <br />[] DWELLING LABEL [] SITE PLAN REVIEW [] PLUMBING <br />[] MANUFACTURED DWELLING [] si:rE EVALUATION [] MECHANICAL <br />[] MANUFACTURED STOP, AGE [] SITE EVALUATION/SEPTIC [] DRIVEWAY <br />[] ..E.F^B samc [] ,.FO., TIO. <br /> <br />( ) I am performing the work on property I own or occupy. <br /> <br />I am a registered builder Or the authorized representative of a registered builder. <br />State of Oregon Construction Contractor's Board Registration # ~ c~ ,~ ~, ~ J <br />FAX~ <br /> <br />(;~ I am the authorized representative of the property owner or contractor, <br /> <br />( ) I will be hidng 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 permiL It is [he 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 Inspectlpn to enter on the property for the of making <br />inspections for this permit. / ~. purpose <br /> <br />SIGNATURE OF APPLICANT: //~-~,~Jt4~/"/"/"/"/"~~ <br /> <br />FOR OFFICEiUSE (~,NL Y: GEODI~,~.J'J~CT: FLecD Pf-AIN ~ ~LIDE____ HISTOP~IWETLANDS.___. LAND USE CASE <br /> <br /> <br />