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ACTIVI'[Y # <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 />APPLICATION ~ ~ <br />BUILDINQ ~? 0 AQ ~ BUILDINQ ~EOTRI~RL <br /> <br />DWELLING ~ BUILDING D~OLITION ~ M~OR EL ~BEL <br />DWELLING ~BEL ~ S~ P~ REVI~ ~ PLUMBING <br />MANUFAC~RED D~LLING ~ S~ ~ALUATION ~ MEC~NICAL <br />=AaUFACTUeEO STO~aE ~ S~ ~A~UA~Oatss~C ~ OmV~AV <br />eRE-FAa ~ SEeT,C ~ ;.FOa=R~O, <br /> <br />NAME OF APPLICANT: ~O~L.~---~' 1~I~_~-~ PH# ~ 7W-- ! 2~/ <br /> <br />WORK DESCRIPTION: t~-~ <br />~ I am pedormlng the work on ' property I own or occupy tive ~~~i~~~ <br />( ) I am a registered builder or the authorized representa <br /> State of Oregon Construction Contractor's Board Registration # <br /> FAX~ <br /> <br /> O0 I am the authorized representative of the property owner or contractor. <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 z~oning, septic (if applicable) and <br /> construction requirements are checked prior to issuance of a permit. It is the responsibility of the applicant <br /> assure that all necessary information has been provided. <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 />1 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 ordinances relating 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 />FOR OFFICE USE ONLY: GEODISTRJCT: FLOOD PI-~N <br /> <br />MAP PAGE: ZONE: CROSS STREET: <br /> <br />SUBDIVTSJON: . <br /> <br />SLIDE HISTORIC <br /> <br />WETLANDS CAND USE CASE <br /> TA,~ ACCT~ <br /> <br /> LOT# <br />REV&fig/96 <br /> <br /> <br />