HomeMy WebLinkAboutPermit Building 1984-1-5
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, Lane, County Authorization for' APPhcatloN="" ~ '2
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17 03 3:3 :3 2. ~ ) DLegal Interest Document
:;~3D~~/P~Tj'lljN ~l.;,. a~~_ttel_ _ '\~. _ -.......L..! QTjPAkCEL [BLOCK I D Plan Check Info Sheet
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011< ~U'~UhCg r~I~9r: t) J:farml ~ JtLlJM~ 0 commemal 0 pubhc
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Jp;;P,T;t~t~HaE1rlrJVWs(LItJa~ UJIl..lDf CbU~rObmke~~D S VALUE
o:fJB'j'O~ ) 'O~'~~IES I J '01' 'elon';.s . I WJT,~.r~y W.?'> posed
I.' u..uO ""I VI/"'nfLL v~)f1JY) L~EX1SHng
o T' St~:rro:)RE~d.. 1ft- LOh1m ~(l ~o..~ J THEPHONE NUMBER
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hlV<.. th, follol'Hll(j h.g1.\ luten."t In th, property ~nwnL'C of n'col,l o ('ontrtct pUlcha (r Dauthorl:l'{d agent wtth cVldcnc{. of authonty attadlprl
I LrtllLl cL.rtlfy thdt any l.n.1 all wOlk I'rrformcd .,hdll b,- ,1011<.. Ln dC(.Qld<lllC, With th... Onl1nanccs of 1al1(. County '1nd the Laws of the State of QrL(jon
[)l..rL.,ullng to thl.- walk dCSCllbcd hen.ln and that. NO OCCUPANCY 10.'111 iK made of iiny :,tructure "'l.thout the pennls5.10n of the BUll,llng D1Vl.SJ.on 1 fur-
ther cLrLdy that u..glstr<itlon Wtth the Btnldl..[ 5 Board ll, 10 full for..., iln<l effect as 1cqulrcd by QRS 701 055 Ithat if exempt the baSiS lor CXcmpllol\
1-> llutLd h~rLoll, and that only sub<..ontlactor:, and employees who are 111 o:.Qlnpllance W.Lth OHS 7U1 O')S w.Lll be used on th.LS proJect 1 HlIVI:. HEAD AND
Clln...Kl:.D THIS APPIICl\rION TIIQROUC'lILY
.............
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RLI D THIS srCTION CAREfULLY
YOUR AUTHORIZATION liAS BEBN BASCO ON THE FOLLOWING CONDITIONS'
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Date ~:z_ U:.-A, ~_
~1~l..l^~ '"' B P 11_ rXZ21-_~ltJ- Tnstallabon Rccord Issucd? 0 Yes 0 No
In..,,t 111ltl.on Gallon LIflt..al h.Lt r1axl.murn Depth
SI'Ll.flcatl.Ons lanh. of Dralnf1cld of Trenches
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'JI,I I V ! Ul\t'ION $
CONSTRuc'rION AU'lHORI7ED BY THIS PERMIT
Jl~sLr J pLJ on
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r~xe.d Fee/
Ulut Cost
Floodpla~n Fee $
subsurface rees $
Bu~ld~ng I'ee $
r':=;ch/p 1mbg Fee $
plans Check Fee $
State Surcharge $
DEQ Surchar~e $
TOTAL FCF $$
IV L- 411. LJUJ
PE..R1lIT APPROVED BY BUILDING QFFICIAL/OESIGHFI: {per ORS 456lB05 (1),-
/-S'-fi
DATE
LANE COUNTY DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 667,4061,
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
'~IT RfVf,RSr J'01\ J NSPCCTION INFORMI\TION
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