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BUILD - 1595347
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BUILD - 1595347
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Last modified
2/22/2013 3:19:07 PM
Creation date
2/15/2005 12:52:25 PM
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Template:
Permits
Permit Address
914 YORK ST
Permit City
AUMSVILLE
Permit Number
555-99-02378
Parcel Number
081W30C 01200
Permit Type
BUILD
Permit Doc Type
Permit Document
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USI~ ONLY. <br /> COMMUNITY DEVELOPMENT CENTER i FOR CITY USE ONLY <br /> <br /> New ( ) Aceeas~ ( ) ~ ( )New (~F~O~()Ch~geof~U~ <br /> ~on ( ) Rel~0n ( ) ~ ~ ( )~ ( )A~, ( )M~e~g~ <br />(~Addifion ~ i( )Addffion ( )S~ O~ )Re~a,~Veh~lep~ <br /> ) ~ <br /> <br />LOCA~ON O~ <br /> <br /> CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br />~OPERTY OWNER and own, reside in, or Will reside in the eompletad stmetarc and will be my own g~neral eonlraetor. I understand thai I mus~ <br /> registar as a Construeti0n contractor tithe structure is sold or offered for sale before or upon completion. Ill hire subcontractors, I will hire only subeontta~ors <br /> <br /> Business Name (please print)__ <br /> <br />Mailing Address: <br /> Street City: Zip: Phone: <br /> <br />() <br /> <br />I am a CONTRACTOR registered with thc State of Oregon. <br />Business Name (p1¢~¢ print): <br /> <br />Mailing <br />Add. ss: <br /> <br /> Street City: Zip: Phone: Fax: <br />4. FEES <br /> <br />A. VALUATION (See Valuation Schedule to determine the valuation <br />bas~l on square footage of the project~, $ ~ <br /> <br /> (1) Permit Fee <br /> (2) S~ate Surcharge (5% x A 1) <br /> (3) gtraetural Plan Review (65% x A 1 ) ~_ <br /> (4) Fire and Life Safety Plan Review (40% x Al), <br /> <br /> o <br /> (6) Seisraie Surcharge, if apPlicable (1 ~A x Al) <br /> <br />B. Miscellaneous Fees <br /> <br />(1) Addl Plan Review / Addendum ~ $50/hr, <br /> Minimum one-half hour <br />(2) Reinspection Fee @ $50,~r inspection <br />(3) Investigation Fee <br />(4) Inspections outside normal business <br />Hours @ $50&r, minimum two hours <br />(5) Inspections for which no fee is specifically <br /> Indicated (~ $50/hr, minimum one hour <br />(6) Additional Sets of Plans ~ $10 per set <br /> TOTAL <br /> <br />I hereby certify that the above information is correct. Permits me non-transferrable and expire if work is not started within 180 ~ <br /> <br />suspended fur 180 days. <br />Name of Applicant [Please Print]:.__ <br /> Mailin <br /> <br /> Date: <br />5-73 Rev 9/98 <br /> <br /> <br />
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