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PLEASE FILL OUT THE FOLLOWING INE. ORMATION AND YOU WILL BE DIRECTED 'FO THE NEXTc. <br />AVAILA. BLE BUILDING CODE TECHNICIAN.~.~:z:~ ~[J <br /> <br />APPLICATION SUBMITTAL <br /> <br />TYPE OF APPLICATION <br /> <br /> L-J DWELLING <br /> [] DWELLING LABEL [] <br /> [] MANUFACTURED DWELLING ' [] <br /> [] MANUF^CtUR e STO E <br /> <br />^G EXEMPT BUILDING <br /> <br />BUILDING DEMOLITION <br /> <br />BITE P[~.N REVIE'W <br /> <br />BITE EVALUATION <br /> <br />[] ELECTRICAL <br />[] . MINOR EL LABEL <br />[] PLUMBING <br />[] MECHANICAL <br />[] DRIVE-WAy <br />[] INFORMATION <br /> <br />NAME OF APPLICANT: <br /> <br />PROJECT ADDRESS; <br /> <br />WORK DESCRIPTION, <br /> <br />() <br /> <br />I am performing the work on property I own or occupy. <br /> <br />I am a registered builder or [he authorized representative of a registered builder. <br />State of Oregon Consffuction Contractor's Board Registration # .~ ? ~ c/~' <br />FAX# ~'??- ,V~-z~' <br /> <br />1 am the authorized representative of the property owner or conb-actor. <br /> <br />I will be hidng 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 pen'niL It is ~e responsibility of the applicant <br />to assure that all necessan/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, y~ ~~/ <br />SIGNATURE OF APPLICANT: v <br /> <br />FOROFFICEJ/..,~ONLY: GEO~f, ST;I~CT:'~I-OODPLAIN~./SUDE ~, ~TO~JC <br /> <br /> <br />