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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 />[] DWELUNG [] BUILDING DEMOLITION [] MINOR ~'1 LABEL <br />[] DWELLING LABEL [] SITE PLAN REVIEW [] PLUMBING <br />[] MANUFACTURED DWELUNG [] SITE EVALUATION [-1 MECHANICAL <br />[] MANUFACTURED STORAGE [] SITE EVALUATION/SEPTIC [] DRIVEWAY <br />[] PRE-FAB [] SEPTIC [] INFORMATION <br /> <br /> ) <br /> <br />() <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 re_qistered builder. <br />State of Oregon Construction Contractor's Board Registration # -~..~'/' o 0 . <br />FAX# <br /> <br />I am the authorized representative of the properly 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 ~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 thai your permit has been <br />issued and ready to be picked up. <br /> <br />I certify that I have read thls application and state that the information given is con-ect. 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. <br />SIGNATURE OF AP PLICANT.,~c~~:~ <br />FOR OFFICE USE ONLY: GEODISTRICT: FLcoD PL.AIN SUDE.~ HISTORIC.~ WETLANDS.___. LAND USE CASE <br />f/Al=PAGE:.__ ZONE:__ CROSS STREET: TA~ ACCT# <br /> <br /> <br />