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PLEASE FILL OUT THE FOLLOWING INFORMATION AND YOU WILL BE DIRECTED TO <br />AVAILABLE BUILDING CODE TECHNICIAN. ~ <br /> <br />J~] DWELl.lNG [] BUILDING DEMOLmON <br />Iq OWELL~a L~L [] srr~ P~N REW~V <br />[] MANUFAC~RED D~LLING ~ S~ ~ALUATION <br />~ ~NUFACTUR~ STOOGE ~ SITE ~ALUA~ON/SEP~C <br /> <br />[] MINOR EL U~BEL <br />[] PLUMBING <br /> <br />[] MECHANICAL <br />[] DRIVEWAY <br /> <br />[] INFORMATION <br /> <br />NAME OF APPLICANT: <br /> <br /> ) I am performing the work on proper[y I own or occupy. <br /> ~ I am a registered builder or the authorized representative of a registered builde[. <br /> State of ~)regoq Const~uc§on gonlractor's Board Registration # ~-0/7 · <br /> <br /> FA.X ' <br /> <br /> ) ' am the authorized representative ol the property owner or contractor. ~ <br /> ) I will be hidng a general conti~ctor registered with U~e ConstrucUon Contractors Board. <br /> <br />This application may gO through a simultaneous review proces . (if applicable) and <br /> <br />construction requirements are ~ecked prior to issuance of a permiL Il is the responsibilib/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 ali state laws and county ordinances relating to building constmcUon. I will authorize <br />a representative of Building Inspection t~/~nter on the property for the purpose of making <br /> <br />SIGNATURE OF APPLICANT: <br />FOuR OFFICE US, E ONLY: GEODIST~T: FLO00 I:~AIN__ SLIDE HISTORIC WETLANDS LA~O USE CASE_~ <br />SUBDII~$1ON: LOt# BLOCK#_ <br /> <br /> <br />