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q.oo RS-' <br /> <br />PLEASE FILL OUT THE FOLLOWING INFORMATION AND YOU WILL BE D~TED TO THE NEXT <br /> <br /> APPLICATION SUBMITTAL <br /> <br />TYPE APPLICATION <br /> ~ AG EXEMPT BUILDING ( ( ELECTRICAL <br /> <br /> -DWELLING ~ ) DUILDING 0EMOLITION ~J MINOR EL LABEL <br /> ~ DWELLING LABEL m ~ BITE PLAN REVIEW m m PLUMBING <br /> <br /> ~ ~ MANUFACTURED DWEllING [ ~ SITE EVALUATION ~ I MECHaNiCAL <br /> ~ J MANUFACTURED STORAGE ~ - ~ ~ITE EVALUATION/~EPTIC ~ DRIVEWAY <br /> ~ ~ PRE-FAB S~PTIC <br /> <br />NAME OF APPLICANT: <br /> <br />PROJECT ADDRESS: <br /> <br />WORK DESCRIPTION: <br /> <br />( ) I am performing the work on property I own or occupy. <br /> <br />.~7~---I-'am a registered builder or the authorized representative of a registered builder. <br /> State of Oregon Construction Contractor'~ [~oard Registration # _.~__~(.~0 '-7 r¢ <br /> FAX# <br /> <br />(' ) I am the authorized representative of theproperty owner or contraCtor. <br /> <br />( ) I will be hiring a general contractor registered with the Construction Contractors Board. <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 as alt requirements of the review have/~been met, you wilt be notified that your permit has been <br />S,GNATUREissued and ready t0 be picked up,oF APPLICANT: /'~' "~"/~/x (~ //~---/'/~'~ ----" <br /> <br />B~DB~W,~IOB: LQTI BLOCKI <br />E~ ~116J~5 <br /> <br /> <br />