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'1 <br />I FOR OFFICE USE ONLY I CITY OF AURORA BUILDING PERMIT <br /> Application: _ A , /) I 21420 Main St. PHONE <br /> Received By: ~.._.~~/~./ Aurora, OR 678-1283 <br /> Date: q ~. ~¢-c/'y J 97002 FAX 678-2758 <br /> BUILDING PERMIT APPLICATION <br />COMPLETE ALL SECTIONS1 1 THROUGH 4 PC DATE <br />1. Job Description HRB CAT <br /> <br />FOR OFFICE USE ONLY <br />Permit NO.; <br /> <br />RESIDENTIAL <br />Q Addition Q Relocation <br />[~ Alteration O Demctltion <br />Q Accessory E~Other <br /> <br />COMMERCIAL O New <br />E~ Addition n Sign <br />~1 Alteration [3 Demdltion <br />Q Change of Occ?_.ancy El Other <br /> <br />Use of Structure: <br /> <br /> Home <br /> <br /> Description of Work; <br /> Truss rL~ or RafterS) ' j NO. Stories: 1 [ Occupant Load Or Number of Employees; T,.No.Bedrooms: 3 <br />'~u~reFeet; Basement: 1132 IMalnFl°°r: 2362 ISec°ndFI°°r: I Garage: 742 I Height: <br /> <br />2. Location of Installation <br /> <br />Property Owner: Kendrick H. McIntire JPhone: ("'503) 678-5777 <br /> <br />Mailing Address: 13750 Cedar Ct. NE Aurora, Or 97002 <br /> <br />dob Address: 14634 Kasel i'CT NE <br /> <br />Aurora, Or 97002 <br /> <br />Tax Acct. No.! ~0177-061 <br />Site No.: 94-2925 <br />Lot: 12 <br /> <br />Subdivision: Kasel CT. <br />Section: ,12 j' Township: 4S I Range: tW <br />LOt Width; I Lot Depth: I A~r~s; . 414 <br /> <br /> I Bl~k: <br /> Zone: Map:'041W12]3 Set Back: Front 20 <br /> I Irreg. Lot; X Corner: ISde 9 Back .,,t 5 <br /> Water Meter Size: LTyp~ Back Flew: <br />3. Contractor Information <br />Property Owner:· I Phone: <br /> Mailing Add~;eas: <br /> ~ I own, reside in, or will reside in the completed structure~ <br /> ]C~ I unde~tand that I must register es a construction contrector if the structure is sold or offered for sale before or upon completion, <br /> <br /> ~ [ will be my own general contractor. <br /> If I hire subcontractors, I will hire only' subcontraCtOrs registered with the Construction Contractor's Board, If I change my mind end do hire a general contractor, I w <br /> contract with a contractor who is registered with the ConstruCtion Contractor's Board, and will immediately notify City of Aurora of the name of the contractor. <br />Contractor Business name & #; I Phone: ,,,., <br />Mailing Address: <br />rn I am e registered builder OR the authorized representative of a registered builder. <br />Architect name; Alan Mascord Design assocs, r Inc. IPh°ne; 225-9161 <br />, Mailing Address: ~305 N.W, 18th Ave. Portland Or, 97209 <br /> <br />4. Fee Schedule <br /> <br />VALUATION (See ",.Va uat on Schedu e" to determine valuation based on square footage.) State Surcharge ~¢~,~-. <br /> Valuation: $ Plan Check = ~ ! ~,~, ¢ C <br />Permit Fee = /; ! ~ ~d~ ~ System Dev, A/¢ ¢ 737 <br />Manufa~ured Home ~ ~-~ ~ TOTAL = <br />Mechanical = ~ ~, ~ Water Meter = _. <br />Plursblng = 9 ~ ~, F~ <br />E~ectdca~ = __1 ~q, <br /> <br /> · TOTAL = .~.:/-.,~ <br /> RECEIPT: ......... TOTALS :.,~, ,?~.J~;~¢C <br />I hereby certify that the above information is correct and that I have reed and understand the Information Notice to Property Owners about <br />Construction Responsibilities on the reverse side of this farm. <br /> <br />Name of Applicant (Please Print): Kendrick H. Mclntire <br /> <br />Sig nature of Applicant'._ <br /> <br />DRIVEWAYS AND SIDEWALK INSPECTION ARE R6©UIRED BY PUBLIC WORKS. <br /> <br />Phone:(503) 678-5777 <br /> <br /> <br />