HomeMy WebLinkAboutPermit Building 1980-1-1
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AC~ITY INFORMATIO~SHEET
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PERSON MAKING REQUEST
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MA I LI NG ADORE SS
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PROPERTY OWNER
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MAILING ADDRESS
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- CITY
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STATE
97/3x
ZIP CODE
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CITY
() tQ. 9'1330
STATE zip CODE
/__718- 79:;2, /-7?(l-75/'A, /-J5.'?-' O()to /-75c;-()r8~
BUSINESS TELEPHONE # HOME TELEPHONE # BUSINESS TELEPHONE # HOME TELEPHONE #
2" PROPERTY ADDRESS 3d.. D~ 0A<;r?-.P.J2 If< 1t1::LI') ,~j)'N1 f,.p'lrJ 6R
(IF DIFFERENT FROM MAILING ADDRESS) f - - ,
3 MAP & PARCEL NUMBER (from tax maps in Department of Assessment and Taxation
(REQUIRED INFORMATION) or from tax statement)
/8 ,O:t,. 0 (, '2.4 oro-oo A GT
TOWNSHIP RANGE SECTION TAX LOT(S) OR PARCEL # ZONING
TOWNSHIP RANGE SECTION
TAX LOT(S) OR PARCEL # ZONING
TOWNSHIP RANGE SECTION
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:
4 SUBDIVISION (if applicable)
5 REQUEST (state exactly what you plan to do)
TAX LOT(S) OR PARCEL # ZONING
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LOT
ACRES
BLOCK
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** FOR STAFF USE ONLY **
NUMBER
DATE
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ZONE/LAND USE:
BY: DATE:
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TIME IN:
OUT:
LAND MANAGEMENT DIVISION 1 125 E. 8th AVE.. EUGENE. OR 97401 / 687-4061