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HomeMy WebLinkAboutAddressing Application 2005-4-25 " .,."I ;;- 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ~.- ADDITIONAL ADDRES.S REQUEST Property Owner: \...1 II' ,........ ~ \<j>,."t'C" \ "'<= Mailing Address: '1M 1),(. r-;"'nQ (...0:-0--.""'" ~. City: I /" III \IIN .."T'"~^..J (. ,"t'_ , State: ()i2. Zip:~~ Person or Agency requesting change if other than owner: Phone number where you can be contacted between 1:00pm and 5:00pm: '1:l.c.()(.?'-I Address of property you are requesting to have an additional address assigned: l.SS' ~ ~~. (L-b.It.).~ C6. ~~,~~~~~ ~~t\........_c. T\-\~ ~i:-.O~:\,.t A..~ 'Sl A. ~T.'). Assessor Map #: ,'1 ~... &S ?1 r-o"p,oo Tax Lot #: Please explain specifically why you feel the location needs an additional address assigned: r~OTL"'" """C""() C:Lt=::A.Q.. uP i\..~~-..J~ (l"..~<.. 'S\'\ Yb.Q"-,::L;' 'Tc. C(\-no~1 """"\~ ~\Il.." ~C~TIc... ""t'>.F_............. ~n.. :::...~~""-O,O.."'tC. b.hOd.(C",,--'-LA- ~L \~u\. (\o;:'C\rZ- ~"',\(.E:~~ ~c=-. 7t>..o....-'n-1 ,-0 ~Qo\Irt.l,,:, ~c.tvlpC l..L'\{'...Ic... 1'"00 ~ -p..,ur~'"", _ ~~'t'lIa..~_",,-~u...t'- - 'I. "'-LOLlL.C"<r. L\'C:.L -c'~t:. '9.L~~r-..","""- ~ ~_M6.~ r~:c:: ("'"'--L\-n.l. ~U\-n;" A..""C'O 1; Irtr...c..~<"-""""'''''' n't't;: "'""t:. \l\o..\~ "'~9...\ut"\) ,5'\ T'o- \..o_'t:lIt.. We.."'T ~Not> Oq~\<..'E. ( b..'-.....&"T'Jrt..~ \~l.l.I.Q.JII.....c..E. "''T ~cu.."'E."'~) Proposed Address: (_~q ~O""" \- ":)'-1'1 6. ~A\.T c: t'\lb ~9\c..;.. '- 6..~~ ~OQ._ ~CL~L A...-C- ?a,.E.S.E,...."T ') Property Owners Signature: J.tl_. /.1JJ-..4.1/ Date: l/;".s/^,,~' , C7~/1 ., Date Received: ,. ':;;'",1)1,,' t?- '\; :t'.'!!:.. ~;::,.!., . "~ 1'.'- '""l-. :.' >:JJ:_ '" 'k ,:}"'J'~-" OFFICE USE,. ".'1' ."" ',r~<:r.t~:i_;ijrD_1":"<;- '- :';-'-J.' ')'<;~ ,~. 5.~.o5 ',. '. .... . "J ,'. .~~.:" ;,:~,,~:r. ',:::..~' 'f;~ >~~;'J Received By: h~ Amount Paid: p,,\(i) ~'W::,:t;;:~":\>\~, " Fee: .o,,\po Receipt #: Reference Number: Tax Lot #: Planning Approval: If denied. please explain: Planning Review By: Approved: Denial: Date: Denied: If approved. new address is: _ Reviewed By: \@ A~~ (Y) Date: ~.~.(D Shared DI;ve(T):/Building FonTIs/Additional Address Request II-02.doc