HomeMy WebLinkAboutApplication APPLICANT 6/22/2012 • S
";City of Springfield SPRINGFIELD
Development Services Department
225 Fifth Street
Springfield, OR 97477
Final Site Plan Review
Application Type (Applicant: check one)
Site Plan: N Minor Site Plan Modification: ❑
Major Site Plan Modification: ❑
Required Project Information (Applicant: complete this section)
Applicant Name: Nathan M. Anderson Phone: 541-743-6738
Company: Fax:
Address: 36637 Cedar Hills Dr. Pleasant Hill,OR 97455
Applicant's Rep.: Bill McIntyre Phone: 541-687-2841
Company: McIntyre Construction, Inc. Fax: 541-343-5974
Address: 90472 Woodruff,Eugene,OR 97402
Property Owner: Nathan Anderson Phone:
Company: Fax:
Address: 36637 Cedar Hills Dr. Pleasant Hill, OR 97455
ASSESSOR'S MAP NO: —1792399 17 b2-32dTAX LOT NO(S): 2201
Property Address: 4777 Main Street
Size of Property: .98 Acres N Square Feet ❑
Proposed Name of Project: Nathan M. Anderson DMD
Description of If you are filling in this form by hand, please attach your proposal description to this application.
Proposal: New Dental Office
Existing Use: Vacant I Tentative Case #: TYP212-00004
Signatures: Please sign and grint our name and date in the ag grog riate box on the next ga•e.
Required Project Information (City Intake Staff: complete this section)
Associated Applications:
Case No.: 1 `t\ ZI 2 - boy Date: 647_// Z Reviewed by: I Ger
Application Fee: $ 7D3.4C Technical Fee: $ 7 ) . (,-4-- Postage Fee: $0
TOTAL FEES: $ yCC.) PROJECT NUMBER: PRSI2,-000b3
Date Received:
JUN 2.2 2012
Revised 1/1/08 Molly Markarian Final Submittal 1 of 4
Signature
I represent this application to be complete for submittal to the City. I affirm that the information identified by the
City as necessary for processing the application is provided herein or the information will not be provided if not
otherwise contained within the submittal, and the City may begin processing the application with the information as
submitted. This statement serves as written notice pursuant to the requirements of ORS 227.178 pertaining to a
complete application.
Owner:
Date:
Signature
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Revised 1/1/08 Molly Markarian 2 of 4