HomeMy WebLinkAboutPermit Sidewalk 1991-5-23
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22!; NORTH FIFTH aTREET
aF'RINGFIELD, OREGON 'il1411
ENGINEERING DIVlalON
OFFICE NO. 126-31!;3
lNaPECTION LINE, 126-316'il
RESIDENTIAL - COMMERCIAL
. alDEWALK I CURBcUT .
AFA..ICATION I PERMIT
SPRINGFIELD
IlI'il0
JOB ADDRE&&. l.Q [) \
Aaaea~ MAP NO.*'
td~~
~ TAX LOT NO."
~':IPT NO, DO \ ~~
CHECK r:p
OOBDIVlaION,
OUNER. N\).. , ~~ ~fu ~ l.L ,
ADDREaa,
aTATE,
crTYJ
*'
CHECKED FOR DELINGlUENCIEa _
ZIP,
. PHONE NO.
~ DEecRlPTION.
alDEWAU<. CURB aiDE _
CURB-CUT, REalDENTIAL _
aeCOND DRIVEWAY (aeE TRAFFIC)
REQUIREa APPLICATION FOR A aeCOND DRIVEWAY("1'-4.1a}
OR A COUNTY APPLICATION FOR FACILITY PERMIT (C 'i\8-21Zl3)
IF IN THE U6.B.
aeTBACt<: _
COMMERICAL _
DATE OF APPLICATION
aIGINED,
DATE,
tAlJJUJ
0'f..J. n .C{ (
WOfIi!K TO BE r-c.........,.... IcD BY, Oll.NER
CONTRACTOR*' b Q 0 rt 0 1(\ < ~)\n '3..-.
ADDRE'il8 6L J2 ~O ~D ~ .
CONTRACTOR iA I. /
REGlaTRATION NO.mOQ'7 EXPIREa,I!J.('-r I q
PHONE, (0 'is In- q+.~t
r-__~.Ji'ilS FOR IN&FI:CTJON REGllJE&T.
CALl. 126-316'il (RECORDER) aTATE YOUR CITY DEalGNATED JOB NUMBER. JOB ADDREaa,TTPE OF
INaFECTION REQUEaTED AND IIA-IEN YOU WILL BE READY FOR lNaPECTION, CONTRACTORa OR OUNERa NAME AND
PHONE NUMBER REQUEaTa RECEIVED BEFORE 1,1Zl<Z> AM WILL BE MADE THE aAME DAY,REQUEare AFTER 1,1Zl<Z>
AM WILL BE MADE THE NEXT WORKING DAY
.. aeE BOOK.
EXlaTING BUILDING PERMIT NO. ( IF APPLICABLE )
YOUR CITY DEaIGNA~~ JOB NO. laf q I ()C::x5J'J
REQUIRED INSFl:CTION&
D
alDEWALK I DRIVEWAY
FOR ALL CONCRETE PAVING WITHIN
THE aTREET RIGHT OF WAY, TO BE
MADE AFTER ALL EXCAVATING
la COMPLETE AND FORM WORK
AND OOB-BAae MATERIAL la
IN PLACE
p
CURB I APPROACH APRON,
AFTER FORMa ARE ERECTED
BUT PRIOR TO POURING
CONCRETE.
FEE&. SIDEWALKS CURe-CUT WALK x'
.10.00 + ~.I5/LF. ( X ) .10\1) ~8/L~ / ""
OF WALK . f\P\ '
\ ~.\oO ~COMMERICAL DRIVEWAya ALL I. x' l-
HAVE !;' TO 8' FLAIRa
TOTAL FER"lIT FEE. $ 3'- IZl' aTANDARD " d.41
I HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATION FOR PERMIT, AND DO HEREBY CERTIFY THAT ALL
INFORMATION HEREON la TRUE AND CORRECT, AND I RJRTHER CERTIFY THAT ANY AND ALL WORK PEf<FORMED
aHALL BE DONE IN ACCORDANCE WITH THE ORDINANCEa OF THE CITY OF SPRINGFIELD, AND THE LAWa OF THE
aTATE OF OREGON PERTAINING TO THE WORK DEacRIBED HEREIN, AND THAT NO OCCUPANCY WILL BE MADE
OF ANY aTRUCTURE WITHOUT PERMISalON OF THE BUILDING DlVIalON. I RJRTHER CERTIFY THAT ONLY CONTRACTORa
~O/:RE~ ORa 11Zl1~5 WILL BE UaED ON THIS PRO;~T~ 3 _? /
P / .
DATE