Fillable This permit is issued under OAR 918-440-0050. Permits (City of Veneta)

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This permit is issued under OAR 918-440-0050. Permits (City of Veneta)

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[Title]
City of Veneta
88184 Eighth Street
P.O. Box 458
Veneta, OR 97487
541-935-2191
www.venetaoregon.gov
twarrick@ci.veneta.or.us
APPLICATION FOR STRUCTURAL PERMIT
DEPARTMENT USE ONLY
Permit #:
By:
Date:
This permit is issued under OAR 918-440-0050. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days.
JOB SITE INFORMATION
OWNER INFORMATION
Address:
I am the property owner doing my own work (initial):______
City:
Owner Name:
Parcel #:
Mailing address:
Directions to work site:
City/State/ZIP:
Phone:
Is property inside city limits: Yes No
Email:
OTHER APPROVALS
Zoning
Floodplain
Onsite
Information verified/approved? Y N
Y N
Information verified/approved? Y N
Approval:
Approval:
Approval:
Date:
Parcel #:
Date:
Parcel #:
(1) Valuation Information
(a) Job description:
(b) Occupancy:
(c) Construction type:
(d) Square feet:
(e) Cost per square foot (April ICC):
(f) Type of Work:
New Alteration Addition Demolition Repair
(g) Is this a foundation ONLY permit?
Yes No
(h) Is this a plan review ONLY?
Yes No
(i) Total valuation:
(2) Building Fees
Contractor:
(a) Permit fee:
Address:
(b) 12% surcharge:
City/State/ZIP:
(3) Plan Review
Phone:
(a) Plan review (permit fee x )
Email:
(b) Fire & Life Safety (permit fee x )
BCD license:
Subtotal of fees above:
CCB license:
(4) Miscellaneous Fees
(a) Seismic review – permit fee x 0.01
Total Due:
I hereby certify that, to my knowledge, the above information is true and correct. All work to be performed shall be in accordance with all
governing laws and rules.
Applicant name:
Mailing Address:
City/State/ZIP:
Phone:
Email:
Signature:
Date:
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This permit is issued under OAR 918-440-0050. Permits (City of Veneta)

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Completed 17 July 2020

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