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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 /> BUILDING [] AG EXEMPT SUILD1NG [] ELECTaICAL <br />~] DWELLING [] BUILDIN~G DEMOLITION [] MINOR EL LABEL <br />[] DWELLING LABEL [] SITE pLAN REVIEW [] PLUMBING <br />[] MANUFACTURED DWELLING [] SITE EVALUATION [] MECHANICAL <br />[] MANUFACTURED STORAGE [] SITE L=VALUATION/SEPTIC [] DRIVEWAY <br />[] PR~-EAB [] S~PTm [] INFORMATION <br /> <br />NAME OF APPLICANT: <br />JpROJECT ADDRESS; <br /> <br /> ' <br />WORK DESCRIPTION: <br /> <br />('~') t am performing the work on property I own on occupy. <br /> <br />() <br /> <br />I am a registered builder or the authorized rep~'esentative of a registered builder. <br />State of Oregon Construction Contractors Board Registration # <br />FAX# <br /> <br />(~) I am the authorized representative of the property 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 s multaneous 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 pro'vided. <br /> <br />As soon as all requirements of the review have been met, you will be notified that your permit has been <br />issued and ready to be picked up. <br /> <br />I certify that I have read this application and state that the information given Is correct, I agree to <br />comply with all state laws and county ordinanceslrelating to building construction. I will authorize <br />a representative of Building Inspection to enter On the property for the purpose of making <br />inspections for this permit. <br /> <br />SIGNATURE OF APPLICANT: ,, <br /> <br />FOR OFFICE USE ONL Y: GEODISTRICT: PLOOD pLAIN~ SLIDE~ HISTOI~IC WETLAND~ LaND USE CASE_~ <br /> <br />MAP PAGE. ZONE: CROSS STREET: TA]~ ACCT~ <br /> <br /> <br />