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81&780-0020 City of Zephyrhill��Permit Application Fax-B13-780-002'I <br /> Building Department <br /> ` • Date Recefved - � phone CoMect ta�r Perminfn D � ;J D <br /> Tu-t <br /> Oxm��r'a Neme Owner Phone Number ' <br /> Ox�ntiWa Address�j l ��1 V�l���_� Owner Phone Number <br /> Fer�Simple Titleholder Name � ,� Owow Phone Number � <br /> Feo S�Imple Titleholder Address r <br /> JOH,4DDRESS ,� J�. LOT� � <br /> SUt3Q1VIS10N C� PARCEL I�� " 'oL � — — <br /> (OBTAINED FROM Pp0!'EfRY TAX NOTIC� <br /> WpRK PROPOSED e NEW CON5TR8 ADD/ALT Q SIGN Q Q DEMOtJSH <br /> INSTALL REPAIR <br /> PROpOSED USE Q SFR Q CAMM Q OTHER � � <br /> TYPE OF CONS'IRUC'iION Q BLOCK Q FRAME Q STEEL Q <br /> DE�CRIPTIQN OF WORK ��" �h n _�7� <br /> BUILDING SIZE �� SQ FOOTAGEC,� HEIGHT �� <br /> —ry t-t <br /> ��BUILDING $ /�/�, VALUATION CiF TOTAL CONSTRUCTION <br /> %'✓ <br /> �ELECTRICAL $ AMP SERVICI_ Q PROGREa�ENERGY Q W.R.E.C. <br /> �PLUMBING �� �� \,`� <br /> � L� <br /> �MECHANICAL �� VALUATION GF MECHANICAL INSTALLATION <br /> �GAS � ROOFING Q SPECIALTr' Q OTHER �� <br /> FIPIISHED FLOOR ELEVATIONS r� FLOOD ZOI•JE AREA QYES fJ0 <br /> L <br /> M <br /> BU ILI]ER ! COINP�4NY ] <br /> SICNATURE REGISTERED Y/ N FEE CURREA Y/N <br /> �Addresa � � _ Licehse�t <br /> EL�GTRICIAN COMPANY � ' <br /> SIC�NA7URE REGIGTERED Y! N FEECURREP Y/N <br /> A�dresa Licehse# I � <br /> PLUfdBER COMPANY , <br /> SIGNAIURE REOI�TERED Y/ N FEECURRFA Y!N <br /> �4ddresa �] License# [ <br /> MECHANICAL �� CONIPANY � � <br /> SIG6dATURE RE01:TEREO Y! N FEE CUflREP Y!N <br /> Address � License# I <br /> OTIIER COMPANY � (�,"\ (,� ,� <br /> SIG�NA'NRE REa�TERED Y/ N F URREA Y/N <br /> E <br /> �4ddress �5. ��L License# ��. , V 7� <br /> IDA11111111111111111111 11111111111911111111111111It111111111111111 <br /> REaIDEN7IAL Attach(2)Plot Pians,(2)sets of Building Plens;(1)set of E iergy Forms;R-0-W Pertnft For new�:onsVuction, <br /> Minimum ten(10)wxking days after submittal date. Requirod onsite,Construction Plans,Stormvster Plans w/Silt Fence installec <br /> Sanitary Facilities&1 dumpster;Site Work Pertnit for suLidivisionsliarge proJects <br /> CaMMERCIAL Attach(2)complete sets of Bufidng Pians plus a Life Saf�aty Page;(1)set of Energy Fortns.R-O•W Permit for new construction. <br /> Minimum ten(10)wurking days after submiHal date. Required onsite,Construction Plans,Stormvster Plans w/Silt Fence installec <br /> San'dary Facilities 8 1 dumpster.Site Work Permitior ell new projects.All commercial�equirernenYs must meet compliance <br /> SIGN PERMIT Attach(2)sets of Er�gineered Plans. <br /> •"•PROPERTY SURVEY required for all NE1N construct�n. <br /> �I..II.d' ! 'a - <br /> Dtt�tione: <br /> 1=ill out application completely <br /> c�wner&Contractor sign back of a:�plication,notarized <br /> If over$2500,a Notice of Comm�rnnemeM is required. (A/C upgrad ea over$7500) � <br /> •' Agent(far the contractor)or Power of Attomey(for the owner)would be someone with notarized letter from ovmer authorizing same � <br /> OVEfI 7HE COUNTER PERMITIING (copy of contrect required) ' <br /> Re•oofs if shingles Sewers Service Upgrades A/C Fences(FIoUSunrey/Footage) <br /> I]riveways-Not over Counter if on:wblic roadways..needs RbW <br />