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SESPNEW - 1467176
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SESPNEW - 1467176
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Last modified
2/11/2010 11:21:03 AM
Creation date
8/9/2004 2:29:09 PM
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Template:
Permits
Permit Address
10647 LEVERMAN RD SE
Permit City
Aumsville
Permit Number
555-96-08241
Parcel Number
081W29C 02600
Permit Type
SESPNEW
Permit Doc Type
Permit Document
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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 /> [] BUILDINQ [] AO EXEMPT BUILDINO [] ELECTRICAL <br /> [] DWELLING [] BUILDING DEMOLITION [] MINOR EL LABEL <br /> [] DWELLING LABEL [] SITE PLAN REVIEW [] PLUMBING <br /> [] MANUFACTURED DWELUNG [] SITE EVALUA110N [] MECHANICAL <br /> [] MANUFACTURED STORAGE [] SITE EVALUATION/SEPTIC [] DRIVEWAY <br /> [] PRE-FAB .~ SEPTIC [] INFORMATION <br /> <br />WORK DESCRIPTION: ~-~/~> <br /> <br /> I am performing the work on property I own or occupy. <br /> <br />I am a registered builder or the authorized representative of a registered builder. <br />State of Oregon Construction Contractor's Board Registration # <br />FAX# <br /> <br />I am the authorized representative of the property owner or contractor. <br /> <br />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 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. [ agree to <br />comply with all state taws and coun~ ordinances relating to butldthg construction. I viii authorize <br />a representative of Building Inspection to enter on the property for the purpose of making <br />ins pectio ns for t his ps rmit. (,,,~-----,,)__,/___~ ~)~.~../, // <br />SIGNATURE OF APPLICA,'~ <br /> <br />FOROFFICEUS~: GEOD. IS'F~CT:FLOODPLAIN SLIQE~ ~-f"ASTQJ~ _ ~,~ETLANDS__ L.ANDUSECASE___ <br />SUBDIVISION: LOT# BLOCK# <br /> <br /> <br />
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