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ACTIVITY # <br /> <br />PLEASE FILL OUT THE FOLLOWING INFORMATION AND YOU WILL BE DIRECTED TO THE NEXT <br />AVAILABLE BUILDING CODE TECHNICIAN. <br /> <br />APPLICATION SUBMITTAL <br /> <br />TYPE OF APPLICATION <br /> <br /> ~ DWELLING <br /> <br /> L,----J DWELLING I~REL <br /> ~ ~ MANUFACTURED DWELLING <br /> t ~ MANU~:ACTURED STORAGE <br /> ~ PRE-FAB <br /> <br />NAME OF APPLICANT: <br /> <br />PROJECT ADDRESS: <br /> <br />WORK DESCRIPTION: <br /> <br />AG EXEMPT BUILDING r ~ ELECTRICAL <br />RUILDING DEMOLITION ~ i MINOR EL LAr~EL <br />51TE PLAN REVIEW ~ ~ PLUMBING <br /> 01~ ~ i MECHANICAL <br /> <br />SITE EVALUATION/SEPTIC ~--J DRIVEWAY <br /> <br />(/')/ I am performing the work on property I own or occupy. <br /> <br />( ) <br /> <br />[ am a registered budder or the authorized representative of a registered builder. <br />State of Oregon Construction ContraCtOr'S Board Registration # <br /> <br />( ) I am the authorized representative of the property owner, <br /> <br />This application may go through a simultaneous review process where zoning, septic (if applicable) and <br />construCtion requirements are checked prior to issuance of a permit, It is the responsibility of the applicant <br />to assure that all necessary information has been provided. <br /> <br />As soon es all requirements of the review have been met, you will be notified that your permit has been <br /> <br />SIGNATURE OF APPLICANT: ~.~ ~ ~ <br />REV 211195 <br /> <br /> <br />