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21420 Main Street RE <br /> P,O. Box 100 <br /> Aotora~ OR 97002-0100 <br /> (~03) ~78-1283 <br /> <br />P. 02 <br /> <br />Sign <br /> <br />Builder NO,.,~"~ .~:'~.~.~..Sub's ................... Tax Lei: No,:_...{..{~._ ......... Section: .......... ,gUnShip; .......... xange,. .......... <br />,.~.~.,.~..H of~.~.~...~ ........ ~ _1 ............... ~ ............. ~.~ .......~.... ~ ...... <br />h~s uy.~_~___~ ............ 7~., ........ es ___;~.~. ................ ::: ...... _.... ..................... .... <br /> <br />I Map NO.I { Zone: I Zone Change~ { Part.: i Conditional Use; I Variance/Adj.: { Occupancy: : Type of <br /> <br />t ~se of B~t~9: { No, 8edro,)a~/Occ, Ld,: I M~R. Req, Setbac~:: Front: I Side~ I ~ear: <br /> <br />~oo~ ~,:...:~.~.1~ ..................................... ~,,-~t,~k, ~_._.v,~-t ~o~...~..Z, ~ 5:. ...... : ......... <br /> <br />Plann{n} Conellsion ChairIan t ........................................ Date: ................. <br /> <br />Historic Review ~oard Chairman: ........................................ Date: ................. <br /> <br />City Official: .................................. Title ............. Date: ................. <br /> <br /> agree to build according to the submitted plans and specifications~ the laws <br />of the State of Oregon and the Ordinances of the City of Aurora, <br /> <br /> furtMr expressly warrant that I comply with the provisions or <br /> <br /> ) { aa p{r{erling work on a property ! own <br /> ) I a~ a registered builder OR <br /> ) [ ae the author{zed representative of a registered builder <br /> <br /> ~ t QKher ~Flea~e <br /> have read this application in its entirety and certify the stated inforeatxon is true and correct to the best of ay knowledge. <br />~,~,0R~ o~ A P,~ ~/~x_~/.~..._~.~_//~..._ ................ <br />{[MAR~$: ......................................................................................................................... <br /> <br /> Mobile Home Fee: $ ....... , ..... <br /> <br /> Pluabin~ Fee : $~,,~.,.~.' <br /> Electrical Fee: S..~_.~_.~._/_. <br /> State Surcharge: <br /> Plans Check Fee: ~ .... ,... <br /> <br />Water Meter Fee: <br />Conneciion fee : ~_~,~.. <br />Cros~-Conne~t ion: S ....... · ..... <br /> <br /> <br />