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ACTIVITY/~ <br /> <br />PLEASE FILL OUT THE FOLLOWING INFORMATION AND YOU WILL 8E DIRECTED YO THE <br />AVAILABLE BUILDING CODE TECHNICIAN, ~ <br /> APPLICAT'O~ [ ._',,~ <br /> <br />8UILDINO ~ ' ~ A~M~ flUILOINO ~ E~RIOAL <br /> <br />[] DWELLING LA6EL [] SITE PLAN REVIEW [] PLUMBING <br />[] MANUFACTURED DWELLING [~ SITE E~ALUATION [] MECHANICAL <br />[] MANUEACTURED STOKAGE [] SITE EVALUATION/SEPTIC [] DP, IVI?,NAy <br />[] pRE~FAS [] SEPTIC [] INPORMATION <br /> <br />EJAME OF APPLICANT; ~-v~.w c~ ~'~.A,'-. <br /> <br />~ROJECT ADDRESS; <br /> <br />WORK DESCR[PTJ?N; C~C~..,.QAAOkOW'x 'Jc'O <br /> <br />( I am 8 reg/slere~ builder or me authored represent~v~builder.~ <br /> State of Oregon Cons~c~on Con,actors Board ~on <br /> <br />( [ am the auto.ed represen~ve of [he p~ <br />( I will be bring a general ~n~mor ,egister~ wi~ ~e Cons~ion Con~ctom Board. <br /> <br />~is appli~Uo~ ~y go ~rough a simultaneous review press ~ere zoning, sep~c (ii appli~ble) and <br />~ns~c~on r~uiremen[s are ~ed prior [o [ssuan~ o~ a peril <br />(o assure ~at all n~ssa~ in~o~a~on has been provided. <br />As soon as all r~uirements o~ ~e review have been met, y~u will be n been <br /> <br /> certify that ( have read this appJication and state that the Information given Is correct. I agree to <br /> comply with ail state laws and counb/ordinances relating to building construction. I will authorize <br /> .~ representative of Building Inspection to enter on the property for~ the purpose of making <br /> ~tPect/ons for this permit. .n / --/~-: ........ /'/ <br />.~JN / ~, c..-'-~. ,/ <br /> <br /> <br />