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PLEASE FILL OUT THE FOLLOWING INFORMATION AND YOU WILL BE DIRECTED TO THE NEXT <br />AVAILABLE BUILDING CODE TECHNICIAN. (~(C~ '~"~ '~[L <br /> <br />APPLICATION SUBMITTAL <br /> <br />TYPE OF APPLICATION <br /> (~ BUILDINa E] AOEXEMPTBUILDING <br /> <br /> ~ DWELLINO ~BEL ~ SI~ ~ <br /> ~ M~UFA~UR~ DWELL~O ~ S~E ~ALUA~0N <br /> ~ M~UFACTURED 8TO.GE ~ SITE ~ALUA~ON~S~TIC <br /> <br />ELECTRICAL <br />MINOR EL LABEL ~.~ <br />PLUMBING <br />MECHANICAL ~.~'O~'''' <br /> <br />DRY.AY <br /> <br />~FORMATION <br /> <br />NAME OF APPLICANT: eH// "~70 '~ '~24~7'~" <br />WORK DESCRIPTION: ~O0~O ~¢~P~ ~ ~ <br />( ) I am ~ing the wo~ on pro~ I own or ~upy. <br /> <br />() <br /> <br />() <br /> <br />I am a registered builder or the authorized representative of a registered builder. <br />State of Oregon Construction Contractor's Board Registration # ~ ~>C~ O <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 of a permiL 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 /> <br />SIGNATURE OF APPLICANT: <br /> <br />FOR OFFICE USE ON[.Y: GEO~.,T~T: FLOOD PLAIN ~ ~;LID~ I~I~I~NDS ~O USE ~ . <br />SUB.SION: LO~ <br /> <br /> <br />