HomeMy WebLinkAboutApplication APPLICANT 8/6/2010 City of Springfield SPRINGFIELD
Development Services Department
225 Fifth Street
Springfield, OR 97477 111111L 1116
Time Extension Request
Certain Improvements Se Final Submittals
Required Project Information (Applicant: complete this section)
Applicant Name: f'/ 5 7-6' - i!-r i., -(11 I7 Phone: ,E-w- `//r-c,1-07
Company: Fax: / -o f 3—/&9'
Address: �55 f ��, t uJc+ C (7 7
Applicant's Rep.: _Phone:
Company: Fax:
Address:
Property Owner: Sa")')^-e_ !-; ci4 Phone:
Company: Fax:
Address: f
ASSESSOR'S MAP NO: /7'0 3-24-2T TAX LOT NO(S): 2f3 O )
Property Address: C9-0673 - ( /i cog: el mo=t O 77) 77
Tentative Case #: U 3 z) ? -De 0 9
Reason for If you are filling in this form by hand, please attach your proposal description to this application.
Time Extension: erra i r cr
Si.natures: Please si•n and •ri nt our name and date in the a• •ro•riate box on the next •. •e.
Required Project Information (City Intake Staff: complete this section)
Date: S/ 2 l(D Reviewed by: 1NC—J
Application Fee: $ 321. DO Technical Fee: $0 Postage Fee: $0
TOTAL FEES: $ 32.-[ . PROJECT NUMBER: P27-6007
Date Received:
AUG - 6 2010
Original Submittal
Revised 1/1/08 Molly Markarian 1 of 2
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. Signatures
The undersigned acknowledges that the information in this application is correct and accurate.
Applicant:
0.64-7
941 4 Date: 7 ' 5 0-6)/6
Signature /
el.; s 1-u 6 of 6--2��f'�Z
Print
If the applicant is not the owner, the owner hereby grants permission for the applicant to act in his/her behalf.
Owner: _
p Date: n
Sign ture _
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Print
Date Received-
AUG - 6 2010
Original Submittai----
Revised 1/1/08 Molly Markarian 2 of 2
225 Fifth Street
ditty of Springfield Official Receipt
Springfield,Oregon 97477 ' bevelopment Services Department
541-726-3759 Phone Public Works Department
RECEIPT #: 3201000000000000522 Date: 08/06/2010 8:38:15AM
Job/Journal Number Description Amount Due
SUB2008-00029 CTY Time Extend Cert Improv '' ' ' 321.00
Item Total: $321.00
Payments: Check Number Authorization
r' " Batch Number Number
Type of Payment Paid By Received By How Received Amount Paid
Check CRIS TABOR-GRIFFIN ddk 5372 In Person $321.00
Payment Total: $321.00"
Date Received:
AUG - 6 2010
Original Submittal
cReccint1 Page I of 1 8/6/2010
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I RECEIVED
,�;! 2-2-7_ 0 Cl
AUG - 9 2010
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By:
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SPRINGFIELD CITY OF SPRINGFIELD
ILIO
TRANSACTION RECEIPT SSpnngeldt0R97477
EGON 541•T26-3753
www.c.springfield or us permitcenter( spnngfield.or.us
RECEIPT NO: 224370 RECORD NO:SUB2008-00029 DATE:08/09/2010
PAYMENT TYPE PAYOR CASHIER:KLAFLEUR COMMENTS AMOUNT PAID
Check CHRIS TABOR-GRIFFEN Money had already been receipted $-321.00
in Tidemark on 8-6-10. I entered it
again 8-9-10 in Accela. No actually
money will need to be refunded just
noting that there was only one
RECEIVED
AUG - 9 2010
By:
,_. • _ .
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SPRINGFIELD CITY OF SPRINGFIELD
ALiimmiii 4 lish.
elk
OREGON 225 Fifth SI
TRANSACTION RECEIPT SpnngfieldOR97477
541-726-3753
www.ci.springfield orus permitcentergci,springfield or.us
RECEIPT NO: 224369 RECORD NO:SUB2008-00029 DATE:08/09/2010
DESCRIPTION ACCOUNT CODE AMOUNT DUE
Time Extension for Certain Improvements-City 100-00000-425002 321 00
TOTAL DUE: $321.00
PAYMENT TYPE PAYOR CASHIER-KLAFLEUR COMMENTS AMOUNT PAID
Check CHRIS TABOR-GRIFFEN $321.00
RECEIVED
^.U, _ 9 2010
By .
Date Received:
AUG 6 1010
original Submittal