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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 /> ~ BUILDING [] AG EXEMPT BUILDING [] ELECTRICAL <br /> [] DWELLING [] BUILDING DEMOLITION [] MINOR EL LABEL <br /> [] DWELLING LABEL [] SITE PLAN REVIEW [] PLUMBING <br /> [] MANUFACTURED DWELLING [] SITE EVALUATION [] MECHANICAL <br /> [] MANUFACTURED STORAGE [] SITE EVALUATION/SEPTIC [] DRIVEWAY <br /> [] PRE-FAB [] SEPTIC [] INFORMATION <br /> <br />NAME OF APPLICANT; <br />WORK DESCRIPTION; <br /> <br />I am performing the work on property I own or occupy. <br /> <br />(~~ a registered builder or the authorized representative of a registered builder. <br /> State of Oregon Construction Contractor's Board Registration # <br /> FAX# ~ ~' '~--~_'iYfl. - ' <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 simultaneous review process where zoning, septic (if applicable) and <br />construction requirements are checked prior to issuance cfa permit. It is the responsibility of the applicant <br />to 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 />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 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 />SIGNATURE OF APPUCANT: ~ .~ _~;:;~'(/~ /r.,~-~''-' ,'~'"~/ <br /> <br />FOR OFFICE USE ONLY: GEODISTRICT: FLOOD PLAIN SLIDE HISTORIC WETLANDS LAND USE CASE <br />REV ~/'Ig,/96 ' ' ~ / ~ - I ..... <br /> <br /> <br />