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~)~~.~ ACTIVITY if <br /> AVAILABLE BUILDING CODE TECHNICIAN. <br /> <br />TYPE OF APPLICATION ~ <br /> ~g~ BUILDING [] Ae EXEMPT BU~INO [] ELECTRICAL <br /> [] DWELLING [] BUILDING DEMOLITION [] MINOR EL LABEL <br /> [] DWELLING LABEL [] SiTE PLAN REVIEW [] PLUMBING <br /> [] MANUFACTURED DWELLING [] BITE EVALUATION [] MECHANICAL <br /> [] MANUFACTURED STORAGE [] SITE EVALUATION/SEPTIC [] DRIVEWAY <br /> [] PRE-FAB [] SEPTIC [] INFORMATION <br /> <br />NAME OF APPLICANT: <br /> <br />PROJECT ADDRESS: <br /> <br />WORK <br /> <br /> DESCRIPTION/ ~'~ I ~' ~J~-" ~4~ ~/~.F'"{ '- <br /> <br /> am peffo~ing ~wo~ on ~[~ I ~n or o~upy. <br /> <br /> ~ ~ registered builder or ~e ~u~o~ed represen~ve of a registe~ builder. <br />State of Oregon Constmc~o~ Controls Board Regis~on <br />F~ <br /> <br />am the authorized representative of the property 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 prior to issuance of a penTiiL 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 reedy to be picked up. <br /> <br />I certify that I have read this application and state that the Information given is correcL 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 APPLICANT ~/~ [. ~J~ <br /> <br />FOR OFFICE USE ONLY: GEO~I~iTRICT: FLOOD PLA/N SUDE HISTORIC,~ WETLANDS.~ ,. L.AJVD USE CASE.__ <br /> /' - "'~' 'U -- <br />sueot~sto~: t. or# CLOCk# <br /> <br /> <br />