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THO 1 ~ : ~6 0 I TV <br /> <br /> CHY D~ <br /> <br />Auror% O~ <br /> ($03) 678-i282 <br /> <br />Sign Pera~t No,_ .................... <br /> <br /> Oa~e:-~_l.~-~-..gl ............ <br /> <br /> ,o.. .... ~ .......... s~b,, ................... ~,, ~o, ,o., .... /. .......... ~e,~o~:.~_._~o~n~h~p,.~. .... ~a~e:./.~ .... <br />Builder <br /> <br />Ower: ~y~ . Ph.d. Address: . ~ City ...... State <br />.......... ' .................. ~ ~zTz6Z ~? .......................................................... <br />~.~, ~_~t~ ~ ~ .... ~.._?,, ........ ,.,.. .................................... ~,,~ ................ ~.,. ....... ,,~ ...... <br />I Map No,t ~ ~one: I ~n~ Change: ~ P~rt,: { Conditional Use: ~ Varian~e/A~j,: I Occupancy: ~ Type of Construction: <br /> <br />I U~e ~{ ~Uildln~: I No, JedroofslO<<, Ld, t I ~ifl. Req, Setb~ck~;'~ FrOnt: I SJ~e~; ; ~ar: <br /> <br />~st~ng Syste*,,. ...................................................... ~e, et <br />~[anning Coaaission <hair,an ; ........................................ Date: <br /> <br />Board Chairman: ........................................Oats< ................. <br /> <br />~echanical Fee <br />eluebiog Fee <br />Electrical Fee: <br />State <br />Plans Check Fee: <br />Systea Dev. Fee: <br />Sig~ Para~: Fee: <br /> <br />city O{fid~l: ...................................... rme ............. ~ate= ............... IU!6L.}L~:[[[~ ' L&(<F..%Y. <br /> <br />~tate of Orego, aid the OrdlOen<ei of (he CltF of Aurora. <br /> <br /> I ~{ perforllo9 York On a prOper%~ Iovn <br /> { aa i registered builder O~ <br /> I aa the authorized representative o~ e registered builder <br /> The work u~ll be performed by a registered builder <br /> Other (Please Speczfy) <br /> <br />W~te~ ~eter Fee <br />Connection Fee <br /> <br /> <br />