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HomeMy WebLinkAboutPermit Mechanical 1977-3-15 .' . . ACTIVITY INFORMATION SHEET . COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED! - l',! (JIIII! 7)a,--rf ;::1.1 ~ :rr-!:'\.-~ PERSON MAKINGREQUEST ' ~71J;s--- ~ ~,,& . ("/ ~~AiLING;;;ESS :Y/~ / I' CITY STATE ZIP CODE I, 31/5.- dg, 7 ti!-/~J.:< BUSINESS: TELEPHONE # .HOME TEL HONE # e PROPERTY ADDRESS ~~~~ ' (IF DIFFERENT FROM MAilING ADD S~j .' VIIiv' DEI!t!~~K .I~/~~~~J~ ""--"'- -,-' .~ -, ... ~-L- . , ~!"--- ! - ../. tlMLING/ADDRESS . 4c~~ a 77/77 I' ci;pv STATE ZIP CODE - I I HOME TELEPHQNE # I BUSINESS TELEPHONE # ~. ~(R 3 MAP & PARCEL NUMBER, (REQUIRED INFORMATION) IB TOWNSH I P (from tax maps in Department of Assessment and Taxation or from tax statement) 4iI/1L 02.. ()f:::,~ j, 3 '3 C) () RANGE SECTION TAX LOT~) OR PARCEL~ ZONIN 4 TOWNSHIP RANGE SECTION TAX LOT(S) OR PARCEL # ZONING TOWNSHIP RANGE SECTIUN TAX LOT(S) OR PARCEL # ZONING ACRES TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP: 4 SUBDIVISION (if applicable) LOT BLOCK, 5 REQUEST (state exactly what you plan to do) k--l' J.';A.-L../ /~.d///Z~.J ~ ~~~j ~ /' /\ DIRECTIONS TO SITE: #flo ~ *" ~p .~ qr % ~' .1'~~4' , , ** FOR STAFF USE ONLY ** . ZONE/LAND USE: 1! 14-33 LAND MANAGEMENT DIVISION / 125 E. 8th AVE., EUGENE, OR 97401 / 687-4061