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21420 Main ~treet NE <br /> .............. P.O, ~ox :00 .,~. ............ . ..................... <br /> Aurora~ O~ ~lO02-OlOO ~j~ ~~ <br /> ................ ........... <br /> <br />~uilder No~~ Su~'$ ....... Tax Lot No, g. Section: ....... /ovnsHp: ~¢ge: <br /> ........... ~ ...................... ~-~ ~ & f;~ ...... <br /> <br />Ovoen .... ~4~.~ .............. Ph,I ........ Address: .................................... City ............... ~tate ... Zip. <br /> G~~& -~t~ / - .......... <br /> <br /> ~ Na~ ~,~ [ Z~: I l~ne ChanGe: ~ Part,: ~ Conditional Us~ ~ VarJanc~/A~,~ [ O~cu~c~: ~ Type ~f <br />~ ~RI ~ ~ : ~ '~-3 ' ' <br /> <br />Lot ,o.:...~ ...... ,Jo<~ No....] ..... s,b~:v:,io,:_~J~_.~l~zFo, si~e, .......................... c.r.. ,: <br /> <br />A~EA OF BUILOING: "al, Floor~O_y_Z..2nd Hoot .......... Base,eot: .......... GarageL~__Totai Area:~fi3.~._Hezght: <br /> <br />HeaHng Srstew~.~. ............... Uood Stove: ................. :...Uater Heter <br /> <br /> Mach~nical Fee : $_.~_.~ <br />~xlst~ ~te4; N, of Gall,)ns; ............ Plumbing Fee <br /> ~r ....................................................... ~, :~L~.~.,~. <br /> <br />PJa~fl[~ CoallS~JO~ :~lraa~ ~ ........................................ Oate; ................. Hans C~ec~ ~ee: <br /> fiyst~e Oe~, Fee: ~C~_. <br />Nlsl~ric Reviev Boar~ dhair~afi: ........................................ O~e~ ................. 5igfl P~c~tt ~_e~ ~ ....... . ..... <br /> <br />City Offielah ..................................... Title <br /> <br />of the State of Oregon and the 0rdlnal~ces cf tile C~t~ of Aurora. <br /> <br /> ) I as a r~gistered builder OB <br /> ) I am the authuttze~ representative of a registere~ builder <br /> ) [he york' eill be perforaed by a registered bui)der <br /> ) Other (Please Specify) <br /> <br />have read th~S application in its e~..j,rety and cert(fy the stateU inf~raat)on is true and correct to the best of ay knoeledge, <br /> <br />RE,ARKS: ........ <br /> <br /> <br />