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ACTIVITY # <br /> <br />PLEASE FILL OLLT~THE FOLLOWING INFORMATION AND YOU WILL BE DIRECTED TO THE NEXT <br /> <br />TYP OF APPLICATION <br /> <br /> BUI G I ~ AG EXEMPT BUILDING ~ I ELECTRICAL <br /> <br /> ~ ~ I DWELLING ~ %'~;~ - { } BUILDING DEMOLITION ~ I MINOR El. LABEL <br /> <br /> ~, ,, ,4 DWELLING LABEL L---J SITE PLAN REVIEW ~ ~ PLUMBING <br /> <br /> I I MANUFACTURED DWELLING I I SITE EVALUATION ~ MECHANICAL <br /> <br /> MANUFACTURED STORAGE ~ SITE EVALUATiON/SEPTIC t ,i CRIVEWAY <br /> ' -'~ ..... - -'7~ -~-~_FORMATION <br /> ~Xx-~"~x~ - ~-, /, v , ~-:~ ..... <br /> PRE-FAB .~ ~.~ ,~,).~../~/~,/~~ev" ~' ~ ~--~/~,~' ~.~ ~' <br /> / ................ ...... <br />NA~E OF APPLICANT: ~i~4~L 4 ~1~1 PHff ~1~ I ~ <br /> <br />PROJECT ADDRESS: <br /> <br />WORK DESCRIPTION: <br /> <br />t am performing the work on property I own or occupy. ~ ~-~F~ ~~~ <br />I am a registered builder or the authorized representative of a registered builderf ~'~ <br />State of Oregon Construction Contractor s 8card Registration ~ .:-- .,~~}-- <br />FAX¢ ~ ~ .... <br /> <br />] am the authorized representative of the prope~ owner or contractor. <br /> <br />I will be hiring a general contra~or 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 responsibiliw of the applicant <br />to assure that all necessaw information has been provided, tj~p~[l~l,I~a~tt yl~ou~t~~n <br />As soon as all requirements of the review have been met, you will be notified it has been <br />issued and ready to be picked up. ~[p <br /> O <br />SIGNATURE OFAPPUCANT~ ~-'~¢',, 'U"MA'i0N"'-'~ COUNTy <br /> ' - '~"-,u INSPECTION <br /> <br />SUBD~ON: LOT~ a~C~ <br /> <br />REV 813/95 <br /> <br /> <br />