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Permit Board of Appeals 1983-1-19
" .; -' ':~'~~/' . , . '-.- '., '~"'" " I " ,.: ..1, " CQ'N$TRUt-'lTQR/PLAciM~,.NT'" ',' ;L~:':;;;-;p::? ~'.I ~ .)tf;~:t.., :f~A ()~';~~ ,jl I J'u2-:P6 R'M;',jI\T__~, l\('l~_/ll~ fA~ '1$- ../~~tM JI\'::U?;~ Vpe;0~<~-~~l.70J~.:;-r GJ~.{\t::)"~-: ."- .V/tl. ,.1 (~;rl..)..' ~t\, Z31rJ3r1:lP'}.1Hft.\ ?,:\'.f,ll.c.~ lj)"M'8:i. i\ll' n.ll,:~: ;~\l a' ~'''t,i,J( 'r?lIA-' tL (-.\.;- L'1', 'l.~": '~tl1Ln.... ~;-(; p.. 1- j, '_" . . '. '. ':"" .. ," :'.. !.. ".' . ',.' '. .' tJTwo Caples at.P'ans 'COi'lPLETE', ,THIS,' BI:;OCK':(l~ "p,LEASE JtJ'lSE1i'B'GAO'K: ,rINK:;,AND "P RTNJ'r' ie, ;,)(l1@j:'J:wO'c'coiii'es""6'fl'P'l.o't',PJ'iins>,:': TOWNSH II' . 'oIl.~ -, ~';l "I'I:RA'-JGJ:::- y,: ,.~,1\lf'''::o=sq<!'~,I:-SECTION.:J' t. i!i.-'"$ ';_:-C,..i 'J~':'I ("Tl,:-';:' ,LO'J' .,' -1~'DOU1"oJ.'~ H~ 'n T.I 0)., ~.r..f. 'J ,...r ,h, ,13 J 5 . 05 '02:3 'Z t~ . i '-'Yo' :-c;n~ch~lic'alr~he2tli:si/'k~' \'~~- : I ,,;., ',','.' ."", ': .' ",: -,...,., ,,:..,'" ",'0"" \ ,"', ."'.'P ""0'" "",..'..,"1, ,tJ.... - "0 Pl'~bi~~')=l~ed:list . ',' , . :3UBD:E"IJOJNi~A:~.l.1'L:: \tfJ?-~PhC:'l~) . " ' "." ,[' 'LOT/,~RCE!---. I B~CK,' D' - ~.,g(!"~Jiq(l ,t4llj:,J1J~: _ ~~ 1.'-.1 ( t::J.rt}( J{ I '. . ~ ~ . Plan Chcd: .into Sl"\eet\ c LOCATI N-'\DDRESS-:;-:--"'I"/ ....ST~ET . ~~c~ l?d f25Y~'" Z P , PR~?O<::" U:".!.."~F J'~uPERT) . , ." , 1I''./"I."....,.c:=... 101=.;-j ",f, P;;.t-/),\ U . '1' H'f'-- iJ ...flhj1W~n,IJ:f'~'" . '" .- . 1 ~-, O;Z;:.-' . 'vt :'1" .': ,r" ,.ttt~~ I (lj .',tlu.. ~ f, { =r-/~'! . '.':::"'J;c"'-.Jtooi)-H' ,., ~ ,.. ill-Jr.,:!:; _~_,' ,;.0; ~ ,,' .. ~'J . 1ft ..~. ..H...... '\--t" ! R~el.dentlart..Jll.lnd.u~tr1-al S~'CTURE"-CURRPH'LY 01PR01'Y' , "'. ' ' "",. " ' . , ',., J"l >,,"'. ,\ ::";;'!.:"'h'~"~'i:'Jj,.., . . .."';)).:JJY0.O' .~~},:', ~" ~;,Aj."y . _'ID/,')Yot-.,((j : " '. .,0 ,; , ; ~,XA.~+.4,\~~", Ii D - f,IF:TlON'Op.PROPO L'~ \..ORK "~'."','t~'r~.,..,,; :"~~";~!'1,,jt 'j';~'('iJ;,( ;~lt~'{l~'i.~."'::"'~~'..~?J,nf:,.,\jt~J" r,l1, '''t'~u;.-;~', ~.:$.:iVA~UE .:ir:"',-;'O" . ,'fV"\7".. _ '~('A" T'~',. . .LrIUr~4;-:;:~~I:t"I'.td'.I.t{:,,, '~":'uT"l.i ';'il;it-:;':, ~,r.(;--1 .' ./Iv) IV.~. ~ -1. . . t" '.~ - , OF -- -- I OF STORIES ":u- "~'F EM' EEe'; "Inl ~., ER SUPPLY 'f:+(' 'rJW" MJ" " ''''))'''' l."l'~' . sed' ','.} , . I 'I' J t~,..)o. '/ ~; 1, I' I' j., t I'. A:;";:..:'" - ~ ,.!l ' ,j. ~ . '.. ' 11'}'l'l" t>., ")1"._& '.. t):...~ r.{"'.Jll,(';':.Jr,r-,\r::v:\\~'to! , r' I')~ ::'.;'~',',/,_' Ex}s'flp:g _ ~., , J.OA:D~~tJ~,.' _,lPJ',kt~~)~~t-~'~:~::,(I~~;':~157\. C~:I1E@D~)," ," ""~"'h~'0k, "'~r.' ',,\", I...;!./,:~.. c'Cr'I'l\["L~!!i'O..r:jI:.U>IBFvRJ_ clX'.:(liAET' -,5 OSR ~[, DIRE -ioNS TO s~:-:;:,...t't1. l\.i :'l~' ..~'~ ;...'-....1 ~ ilM, .!:l ,,;,_~-,,- 1"'f"~":J 11,..;; '.,.'j{-' ;r~.....j'~~~J: \- " , h' ",,: ?iJr~~; :\',cX/I"M,c:\' oJ ,t'.lJ2. " : _ :,:,rrr 'Iv.,.)i ,%l.lJ".,11J, 8lJ]l:ooY " 'r,t ;<l1:;;\,I:'I~'.:,nr!"''J1 "'i,:i~,~~nl."O".I'~~~~:,0': "I':I~^''', 'ft)~b,~W':"" ':.', ':' , U"JlJ..:.l"Tf' r",d1:ri.J'Il~,^".'HI'j 11~..J t. ~'I)G'1~'''-:: J~ v~t('\JI.J' (''''tt\'YJT'''', :..">' - , ,/ " " . l0) .'.. , ' ' " ':' I !lAVE CAREFULLY E,XAlHtJED THE COMl'L. ETr;O"APPLICATION FOR PERMIT ,. and ,do, 11(~rr!tJ'f"lr'_".' n r,Yl th" t: 'n l] 111 r rm., t.l 011. IV:_'f'!'JYI I.C' .Lru.:? i\!1c1 ~orrl'r:t ,lI.ld 1 fin 1:11'.'1" certi fy t:h<J.t an'y and a11wo;k' pe~'f6rmed' si~h!l iJt~ 'd(jrl~!J iri ~'aJc'6~~d3Iicg';';itW't:l\~'for'd i [;'ci11~;''''' f\.'r.:3in'7rl:'( 'it;' ~:";"d' tl,.;~ iJ5\./s~ e,f tl;~':~5t!i' t'~7~.-~-;flCl;.\~I:!fl' r,,! :1,1 it, i'n;] to. -the ,~or\ $e~Crib~? ::h~r:'r;in ,-<....~~d...t~~\J'!;l~C.~Cp~A!!SY..;':"t~ 11" ,b;' '!p<;~.8. ?.! ~~YFs,t~~~,~,~~'''!,,'',"'i th.oU...~f V\~ iP~~-!-:m~s;>i.'?I~~;o.Ej ,t.h~".~~Ji:,lgil,!,~J' ~iy}s.i~~ ":?~~ /.uyU.I?_:rrc:.;:r.ti..f y that. registra.t.l.on.. WI. thr~,her?u.l,l~~r,,'.~Bo,a,\~ 15,; tJ~f,u,l~!,?,:,ce, an? ef,fi'c.},~.af~\e~,~.lT~,1 by ,01<5 ,,}.Q..l :,pS_S, "~~]<! L. ,~.~.."v:-e!'1-f',~"J:h.,;,! ,~a.;~~~, for.'",~xf~g~:~H}H 1]0 notr..d hereon, and' that onLy 'subcontractors ~a,n.d e.mployees,..ho1'. are. ~fl co~pli.ance".'-:ith ORS 701. ass wi 11 ~.< u:edJo~ ,.thJ}"(r;:~j,:ct ''';'f..}-1.r'~),E ,.;u:"~i.~l-1p..CJlECY.ED' TlIlS APPLICATIONTHOROUGlILY., ' .' >. " _. ,.;., 1 . '.' . ". . ,..,. .,;l,,{.... "t. ... '"',- ". .-. ..'r.'.. -.. '. '-." '-(")'.~f-_":l.jo" .'. :\.. "~_-""" ;..~k".f., ").11..~!,...'1 "'~-I"~J:...'~.. 'l,l.P.i-l.."~:;I';1$.n..- fif~ .'1.r(lJ,Jr.f"'I""'11 """j;l)..f;,ll'rl; .,\.:~~.fftltf,/) rl1., ",,;')!Yl 'i;h,' -.I, ...~'(" o.\'-I:-:-;'~ ,r' .. ! :d-d:..; e_b';'~:" :~~;\~L';::;':~'/,,\:u>,{: rnqJ '<,?:jq~,~. X~;(2~~1$':,01J:J;~~;~ ..3~:'"6:::::o;'''': Nt'.M.E (plcas!C p"r-h~t) . : I ;'.,"; P.c;;~;'TU!'E '..: . ..:. ;.. ./7 -'. D,~_'.t.c: ,". . [JAgCllt- I' ~ "i", o:.;'~' "l,,' .'- u' il.-r~.tr.,~I1-..J 2. L"l.[,Jr,f..tKn ,f:'/.l,}. ":;1Ir--.1,~' t. ....:r..)'.;\t. .'1;. ~.'..'!" ,~t,,' I!' ,I. ,.. t:" " 1 '" .:obi)"/' ~q.I'.,J', t!j.I~_ Un) .~; ,";"'_l~#"'P" ""l}.~il. 'f':-,~-'--,.' 'v ~ .~~ o I?LANNJNG/ZONING:.. . ZorterJrV ' P~r:tition.'# , .par.~eJ.. ~. parc~Y's"'{;.;e" 'J.J~ .,...., ,- :. -.; ,1.. . ".C......tj'i-C5. t':1QC' "tj~:C7Y-;'~y "-C"I''Il.';i.,,;'~t''''I,;,)'//7.' -l-;:~'''! ~! ~~l..;' /~/' ,..~ tr~':".. 1."i7/.0/ ~', . .t-11:1l~;U~ Sctb~dS;..i., :fr:.>n~"~(/.. ~ _ L, ;~:,~e ~::< :-r.ter~o~ .~;.,: '~i'l;'r;!,,?l;~E.., . :;'. C'-,,___,P;y' "P.!". :/\."1'-'i:I"~U~l?J' h-~ ,'j' 1'.1:.i -"d.-, l'>")-lie' ht::;:"'I~I>:::, :{roil .n" 1J.j:t, ,1MI"lfli1 3.n)nn ,','1.1 r.1(I",. \~~: '. Comment,s: < _ l J II y\:.V m.l ~ ' [. _,' ......" _i-..F.t. '-'-'.:-."',', ,c,... ." _' "~"'"'" \.'.~,jJ}f-:;,t..lrf"..2J"'~~"r""\ji.-\j'jr:..",~t,';."f;1r6''].r~~';4't.~.J,);:,~,:,.rt,1.-/J';-D''~3 'W2_ ..' . . r .. r ~-'.. t..j,. , "., ...,;1: - / ,.....'. " ":"'<1,~~"<. ',i, . 1 "';: C;ate._,' . ,,,/~'7:- ~ '[!1F~O?D~LAI~.':; In:of:,~.~~., h:ta:l, ~.r~,~~ Jq~j h~~~~~ ~r "~t~~4ths;~i:~i,;.;,~~'~:f'} ~,~'(;':,~~ ~D' o RURAL ADDRESS;ING:"' r;pD COC!RDI~An: N ,Ed""'" .:. Date" ~ ...."'11 ,1'. : ' g1'l':NITATION':: >::s':.:i:~;;:;,::~.i::< "". ,! .':"':~~~~:-~~:{'i}~~~~it\J~:'.R,f~b~,d;~s~po,~;~~~,o:~0.' ,: y '1"'\' (,'f trlr8)o.....}. \'.j 1"~"'[1\""t~~1 J "'e. ,,.,~ I~',,"" .',' '_ '."'.. Ll'rieaJ'.F~et'~~ I- III ,..I.,. ..n. ....." ,I' MaXlnnUl1 Depth ~.of".D:t;'_a~nf~~i?I'I" .~, _ .... ?f.r_r:~!jcl:es , ,'"f.I.}~~.,.l ~..,.!'J.'I''''',!h'1JJ f'lJl' 4'" r",; .',.l,,,;' ',/.' l' sdk..K -I'd;....... ..,:",.J '........cloJ.. .;,I.VI.I I.I,........:.,... .1.:.'1-<'1, .'.....~'.... , '" '. , Installation' '.. ~pecifi'catio~s: '. "G~j'l'on Tank . ".--.,',~ .I';i~ , t. ;, ......... ,-.. ".J'-' . ,.. '.. ,.~.. ,: 'I ~',J'_-' ,- 14 :PI- ". .'.,M....... ",~ ""',:'<" .t , Comme_n ts : , . ';#cb'.A;';~-l.~ .--, h11.:J:l.( m Om w'-ui...:' :.." -' ';J l"'.'l}' .",1 1h";;-,,~'iol; ~'~ ['1...."1'1" 1,b'j..'. "n,~ '~v,_ '-'V.l:r)".rr~ 96- '.J'~ ,!'~ ,:,,'('f ~" .,.' '.. . . 'Date'; ..~/. - t.-........ '. ~ ' '.. 'oJ'i,j If.'' ;;-1";;.1,J' '~T-,.t .-_'i'l .. ":!'''fl .i1'i--;l;1 <'<:..t 1'/, j'jlj -. 'j-I',r.:; ....; 'n'{f .t..;:-:::lJ C_'{;jj- .,flr-~~h,l ';'''{'.j''. ~ PL~NS"'~XAMTNAT;;rON;:?f.if. fyp.~;;: ~,.,~.,.",::::'] 'G~';,up;":'l"~":~e'\' 'r.ui,e'5';:M.rr:ll~lr~.,"r.;;'1U'., ~"I ...~'i:.i'('~' :r' ;.'1 .'l..',.\' ~ '~"'I "-""~"'-"!'.';~1.11J ':l'\J '.1 "l'-:.~!':h'lnit.~ ~-,:.,,;'-"iv;: ,,~9"'J~;.tI'IJ' ,':>j-'. .',; 'il;(1, jr ',r ;f,........~'.,;I' ~: .~~;.uOEJrtt.s":.~ ::~~y~~; J~r ~;l'.~J::):olljl.'I':. ':',Jj-:,...j'(:~,:~'"'; *.l,'t;B.'f.)tjt{Jk1~/ 12Ef1?Ijb~~~;'t-'6,t:" l);lt, . ~.:~'-~ '-f~'ir';S~RE.VE~SESIDEOFPERMmAND. J !'J1"'.-c' 'Jfl:l'..-....;!.); ~_-1.,~,::..:.~ ,'e! t'"U-l.F-{~>"A"'J4.;q i.:i'l,t%' f'~. :"1.." (.-0' ~',-, . l"'WClOSJ!RI='~'l='nfl'IN$TA~IATIONJ..)1 ()1 9' 1!.).,t'"' ...)....n,'~~~. 1 ''/~l_t;.(...::. ,.7t. -~r ~' ~RE.QUIREMENTS:\"~;'" "1 tUo. .'':l (III} 'Il' i:;1 ....:_1'-"1" '......:L l-~ dIJ -;. ""I 11 ....' "I---;agrlQi &~:,~.I'" . ,. _ . '1' A. .~ Date: ,/j aJ . .' I ,II . ,Ill n L ~. tl> ,'~ 'tr ',' ... ~ '..1 " '" CON'STRUC'l'IONJ ,AUT MIT . ....JI." . . ~,),,-;r .. <j-'~-l.''''r: 1I.1:d \iY()1l rt7\ 'F' .~pl'ain;...F,eel;"~j_;.l h~:', .,S....:,! _.' . 'W- S,q'. Ft. ,I~ s~rface ,Fee's' ;_.,~~,S[ 0(7 '1 . Bu id~n,~1J~1;~I?- 1:;',t..l., . ..IT'.. '$ ~1~.q) s'~.wer!s~brm" Drainj'\vater . ~.--.J0. ff() Fixtures " S $ 'r ~ {j'?? . '~lf1.(j,HO FEE~,,:A1D ~y, ~k D~ ,By, /~/./}}:V, , , ; ", 'D~t<" j;1!~!o/~cf3, ~J6' ,(./;J,.9/&5. pERMIT M'PROV~O BY, BUILDING OFFICIAL/;)ESIGI:lf;E.;'r;;:'~r.'O\~~ '456.805 (1)).' " . DlITE , ~ . , .;"1 LANE.. COUNTY DEPARTMENT OF PLA~NING & cOli~lUN.ITY DEVELOP~1r;NT.~'/'125 E{\51' E.IG_HTH' AVE~UE; ". .' ~ -' [j , PIUJ.1!biri9 "Mechanic?-~ ~Planstchec~'Fee ..,' Stat~e Su!,qharge ,~5,' TO'T~~ ;~E :/1 b/ ,,"I ' . '" .', , . .. TOTA~ VAi.UA~T~ON _. ",S'" PIRMlTS FOR ALL ELECTRICAlWClRK , SHALL UE SECURED FROM THE STATE' OF OREGONI,OEPARJMENT OF: COMMERCE, ELECTRICAL SECTION. '\ii", .. ~. SEE REVE~SEFOR 'INSPECTION INFOi,MATidN ",". '- EUGENE'; 9REdoN .9740:1'- \ . ..~:', -;. '-"."~' \ .:'" ~ " ,," " ....... ", " ..... .{.... ~~.~::A.{..5.~r.~~t=.:~'..~~~~.~\.:..; ~~.,.! ~...,' t';..:..... .:". ,",,(.""." ,.r':f',~';';';~.t,-;.;,,-, ("'.-.z::... ~,,~_ ~...~.}.. . ':>..1 ': :~.....t..'.,; ~.~'.:'~;.Ijt. ........,:'..'};./:. ,P' ~- ...._.~~...-:o... .;.-.....t..... _ _~..::>.. .'Z..~.". . ,..:'." ~. 'I. .~-I_...,. ,_ ,< , SETBACKS AND ,OTHER CONDITlONS-'Of ARPROVAL MUST 'BE STRICTLY' OBSERVED, ,vIOLATION' CAN 'RESULT IN REVOCATION OF THIS PERMIT. _ _, " i ,CITATION~~?ER;'PR2VI~I6N~OF:L~iEfOUNTY~S INFRA:t~O~ ORD!N~NCl; A~D(DR OTHER ~EMEDIES ALLOWED BY ,AW, """ , ;~'", WHEN READY JOR: INSPECTlON'CALL,,687~4065; A MINIMUM'OF Ai' LEASWi24' liOUR'ADVANCE'ilOTicE FOR:I'NsPEcrioNREQUESTM[)ST,(jE" ',;:"-' ,.. ~IVEN: H~ve S,~~,\~.fpll q~ing i~f..orm,at.i.~n. r~~C1Y:':: P_er~j}'pu~b~(, ~j9b' ai:ldire's~': r~y~. orr''''insp'ection~. '.~t1~;.i t~~wil'l"'De' rea~~~'" ,:. ".. :,~, your name.a~.d:.phone..~~~.~:~~"..:Jl~'~Clny~.,~~e~~~l ~.lr:e~~~~o.~:.,~~~~~~~.j',.:,?:;:~.~.. .,'~".~\~~~_ ~:" . . "~~~\'. )~..-~~:l" ~).L'_. _ ' BUILDING OIVISIo'N: ,.. ~~* I' '" ........ .': .':~ '.' .~.. ""~. '. "f,' ',_ , : .' , ,I, , " " '. , 'j " b t -1. '\. t...... .~..REOU!RED.IU~PECTIONS::")~:-: .:~:~:.,~.;:. ".', '.:: . \. ~\~~ ;~. :..~.::- .. ~~ '. .. _~--,~~r:'-:. ~<-~~'''~'~ i ,-, ~~(~}_'_.~.. J' .\ 1) . FOUNDATION...INSP.ECTION: To"be ~ade after~tr~enches~ are ,excavatea and Jorms erected .and...wheni"all-,materials for the..-iou'ndation ~ , ~. . ~are_: d~~ ;.ver~~d. :o.n ~th~ .jbb~ ~,.-Wh>erEL~0!1~'r:~t~.cf.rb~:~'~I~c.e6tr~ l~m)xjng, _p] ~nt (c'OiOn]QrlY...t~.r01e(Plltr~.n:sJt3mi~~dn~Li.~. td.~~.'us_'e9~; ~_. ../ .. materrals.need:notbe_on.the,.job! ~1...;....f~." ' ,,'\r'll: .~\.I . il;,~,. "1.,,~ ."- ;., '.......-.. _,' ~" -- J'.,;,r.,-'",.! "~.'l..~~.lr,' ..l-'. }'r-""\(" 1, \ .~\ ,...--::......1. t., ~ _t '.0",.;7-\ ..' I .'\~ ..~t ~'l' ,"'\ :,-_ g) CONCRETE'"SLAB10R' UNDER~FI:OOR 'INSRECTION: :.,JOLb~"!TIa,<l~ af~,<;!i, a,ll",;Jb:,sl ~i?:~I.!lni~r;,f)oor 'ku.!:!1!i,!!g,~erYise;,egui p.a'e~(c..: ,. :,'~~J condult. p'plng..'ac.cessones.and other, ancl:l;lary,equlpment l,tems are In'.Rlace .but before any concrete.ls'pourea ' ',. . ( ~ . O:.~f~~_~.~ s:~:ath.T.~~ '~.~::~.l.l:d.: :!.n~~~Ud1n~}~: "~~bi~?~r0V"r( ~..)t~~. '.~. _l',;"':'L~:J~:~!l'~~\ ;~..;'~Ci~~l~ \C"{~~~~ft::':'~~'l.f ~~, ~~~';~~l ;:' 3) 'FRAM'ING"& . lNSU'LATI ON INSPECTIONS :,( T'o ,b'e,made afi:er'.th~: r~of,' alln'r'amin'g; 'fi ?;:b"l oeking an8"braci~g' are, in pl ack~nd' ; . 'a1,1 Jpi pes}~,f;repl aces/ ~nd- chil!1neYS\:and ventsfarei c'ompfete'jand alT"roU'ghlel ectr.i ~a 1 and 'pl umbing are approved. '.All ,,' ,_n. . wall;:,in~sura'tiOJi~ana-yapor barfier are..Hi:place;~,---.~ ~l' 1-', :' ~ --'\ ~- " ..' . - :~. ,; ;'-~ .~.' ',~,::::c~'~'- -- , .,.:........ 1'-~'., ! [:--,.-- ...:...- .c;,Ji.<f....;;, '''_...-~'''' ,..-....w. .'l'~ ~ ..-.:,...~t::'. J!'":',,~'" .'-,\-' "[1') :~"~ '\'~r"'," " ..... ./ r,t l.r~~,. 1';.'\ r ..,fri... . (\\"11'/"" I ",. ".'L.{'\.__.:"!.'....1"{')~~f,W.t"I', ,r.:rl '\~\-'i 'I r,,,,,41,.,I:ATH:AND/OR.GYPSUM.BOARD~JNSPECTION:..To_be made"after. a ',1,1 athi fIg .and ~gjpsum\b'o"rd .fi nt,r.i o!,_,'and -e'xterio,r:.;"i s',i~ :pl ae.e~" l' . but~before a~~-Pla~~eri.~.9~i~"a.PPl~~d.'or"\bef~r~.gyp~ur~l'~oatd jlo~nts and fasteners ar.e ~;~Prd, a~dr.rinished;'\. '~.'~r" .... :.~ _. . - ".'-., 1 ':,_ \ t ~. .,-. . \>.1.1\ ....:~ _l.J/1.1 ..1<' _ . J.. ...,.,} ;'. \..:11 i. ......._i..~ .1..\,r'. i._)l... ~i . 5)' ;cINAL 'INSRECTION:' To' be',made: after'the b~! 1dlng iSieomplete' and before, oeeupane~ ,..~~, ," --....,... >.., _ .,'...'.. ""..., , ' ';;, :"'I~.,~r.<tl...t>l {.....:,\~...:~.. ~"J; _II 'l"~;' l>"::':'~;( . .,.'''',"'''...;' ~:;l.'-1 ~,-^,'" ..'-,' :._~:~.f., '-',~~ '.. ~"'''\ t ~_, Ap'pROILAl!,p'E_QUIRED: I !No~work<sha'l,l~b~:d_one.~on ,any;' p''.r,t ,or. th9buil,ding;or,..,str,uet.ur,e.be:;,onCl_ the pOint,.indieated'in, ~aeh\'. _ _ __' '. : su~cessi ~e. i,ns'p'~.cti.on i~;,tr.out f,i rs;!; .~~,tain in~ the aRPr.ov"a} of ~t'le .buil,di ng .qffi ~;<a}.:~. Such:'appr~val ~haJJI ~'e. gi yen .only\,..,. ~ ~ ..,~:~~~ r:4. ~~~~eC.:i ~.~}~~!,!~..!:a,~~__b:e~,~~,d~t~~ ::;:~~:".~~~c;~~~~_i v~.~ ~,:)9!,~n ;_:t.~: ~o~~;~tr~~t-~ o~ ~a_s'~~~!i..~,~~d ~3:f.I. e.~~:~~or. .,,:~e ~.!.nsp~:,~ o-ri~ J '. h NOr(:'J 'All b'ui ldiilg'.pennits';'e'qui"re'i nsp~ctions. for'~'the .work ituthor1zed{:s'uchas bu't nor fimi'ted" to:' ,'"7t -!', ',. I ,". .,' . :,. . - . A.":.:BL'OCK. WA~~: '. T'o ~~ ~lIl'~de" a'ft~~.:"\~:i-nf~('~i_n~---il'~":i~"Pla~ei'but before"~any'gr.o~t is'''p~~r~d'~\' "Thi.s~'insp'e~tion)s. . " i. ~~:. to .l\'hreq~ibr...ed fqr;d~.a;:h _b.ond. b.~amd_~po!-lr.. I:r,he;r,e- wi l,l b'e'"no,.app"ri~~l.. unti) the PJ~~bing.an~si~1~s~rtc~1 i nSRecfi.Ori's .. :~ a.ve. e~n,m.a e a'1.d approve: .... ,'" .... .-", . . . f;~' '. ':',.>'. ,..... ..~. c....: B.';.WOOD STOVE: .'To he .made:after~ completi'on of.masonrv (if.app13cable) 'and'when installatioTl is: comolete._ "!1;s'tallation shali be in accord'ance with~ an'approved nationally7recogn{zed testlng agency dud. the manu- . .. factur~r,'.s':.i~~t~,lJa~i9n~i!ls~r:uc.t1qns; ~. c. ',~. '~. '~~'.. ,,' .. .-~ .... j_:' !_, ~ .__fl' , \,",,,~~~,\,,, .' C~:.~. r;~-(~~l~~~~'~-;~~~~-\;~~~_~ti~; ~.i~ ~~re~~~~'~,~f,~~"V"t~.~.. ~Q.bJU~~ 'b'~rDe _.<s~ c~nne~~~e~.-;~.~~' ~'.;P'Pf~'~e~~ s'~~~; ;~fj~pi1C - \ ~ . _-~~A(:'.~ ~...':. system' for: -setbacl(~requirell)ents; blo~kl ng ,"'-fOOtl ng' connectioT)" tl edowns~, skl rtl ng t"anapl umblOg~. -1.,. ',." .;.-' ;' ,>~..connec.tions. '.., .~. .. -..... 'f;i-. .. '., '. 't~"~. .. .:-. .'4:_": .... (, 1''-''3/'. Ie ....' ~.._',. .~ "~,.' .,. -' ..- ..,.:'..... . ...~... . ,-.~'.Y"-"'.", .'._.\ . !.,(lJ,CFoot-ings ,and. piers,~'to: comply with;..State foundation"requirem~nts_.fof' mobile -homesor ;as"'y.ecomriie'hde"d' .. --:rI":'\~'-bythemanutacturer"'''-i, >. '.'.., ~.._~). J. . .... '....:.)'_.'.. " '__ ,J~":;' ...,;. " '- .' .....:(2)- Mobile'home minimum.fi'nish' floor elev~tio~ ~ha~ll 'be certifjed ~~~ ~equirel;bila- f1"oodpla'in' .~ . ~ ... ....::~ .....mana~gement':,1E~tter... ';:.~~._.._: ~_ ';.'.?,..!. .1.' ','. ~ #<.1 .:r:'t::.'~.:......1J.)"':"'J_~~ ~r'::: ,.1 " . \~ -- (3-) "'~Mobile: home ti edowns,. when.~equired, a'nd, ski rti ng shal'f be installed _ and readY.'forinspecti on ' -l..~>'_,_. ~:,-;OJ :Wfthin~at:.least'.30'~.days afte'r occupancy.:. Tiedowns and skir.ting.shal1..be..installed',per~'enclosur.e,. . .,......, --.. '.._'. ~ . ~ ,.' '.... '.' I.. ,:, . w,. .' ,', .,'. I'r. . .,or" . '" -'>,<' '''''(\J-.. ,.1..':)-l 1:.,:",,>,., .... ...... . X 0 _ ',ll "',~;~' . -. Jfl_\"'.('l "Ij', ;.:1' ..~; 2'. "'D.--~s~iIMMiNG po6C: ~Befow:'g'rade.wh~n "sie~f is,in place and before.coricr,ete'.{s ~poured';- ,'.Abo\"e.gr.a~de 'when~p~oll". '~~""~.' ." t,., 'c'is.installed'._~-.' -i.,,' :'..... .." , P, ",~" "lU .~ "_ "> 'l_,:".J':; .1.",~~~ .';' ~'__'l.:; AP~~OVED 'PLANS':;;UST' ~EON THE JOB :SITE ,;r,~l iIM~S~OUR';N(?WORKING HOURS, THIS PERMIT WILL, EXpi~E- IF'>JORK,DOES NOT :SE'GIN ._' ,",. ....-. '_ __ _._.' ". \..~ ".~__"._"_'"'" . __,...... _ __. .~ ,,__:n.. w I. ~ WITHIN '180, DAY.S~-cDR :1, WORK IS'SUSRENDED ORABANDONED,cORiMDRE'THAN, 1 BO DAYS., SUSPENSIO,N~OR REVOCAIION :MAY.:OCCUR'"I E' THIS , '. PERMIT WAS ISSUED ON ,,THE'BASIS ,OF! INCDrIPLETE OR'ERRONEDUS "INFORM~TION, ; , ',' ! ' 'c ' ' , ."~.' . _.' .:.....:.~.~.". _. ,'_' .." .-_ ~ :- ..~r:,;'.' .' ~:'.-:' .~.' ,,' ~.' . 'f,,,,,,_..~.l"... , ANYDNE ,PRDCE'EDING'PAST 'THE POINT DF, REQUIRED"'nisPECTr'ONS\lILL DO SO AT' HIS DWN RISK ".'" , . ',--- .:",~\<..,.:..'tt~:w ~ ,..~.~-{7;-SUBSURF~'c-~'ANDj'lTi~~AftVE ~1~AJE'b~sp6sAl' SY'St~MS<\"':.' ~~ ':~<'.~~.~' !'/:'< '.' '" . . . , " . ~/:;.:\: ;. " , . ...:\ ~ ',.' " " , " ;1 ~ '..:... .' . _.....: '\\ \ , ~.~ .-... -'. ~-.' ,-... en- ,"'" , :''('2') " . .,~ r"" .' t'.~(.~ f,'" .' " From:\ !nterior 'property 1i"nes" \..!. ~'Ij" ~d~dge'.of:,road right-of7way .. .~. ""\ ~B~il,~i ng)..f~l.mda t,i on...,. :.:...: ~," . ,j"r~.:. ('\ We1l s" otrer -water ;sources ~;r:'.. ~....,,~-~'p):::' .~~ t, .... (r"t ;:;...~t~ ...:,,;.. "': ~,'~' '. :.-~ . -'.,... ~1 '~', I. .' ...... " " '3-/1"'"<''' \' ", '"',.,",, ~, '."-..,f:.!..\.~...;:j_~.. .>-J....'l!~~.~ ~ , "~if ..,~r:{..L ~>~..'1._:-1,~. .~. ~.- .""'-~..... ~ .." ."-' .~-,.......... ..-....;. ,..,- ..! " ,.., . ,,,,C ,._'\ ~,,)Y\\' . ;X;.,'o'f \:,~...:.') ,..... ~ ---'," '~'r-". -...... - ...-. ' ",,' ", J1)""4 I: " . '< ir)( ~ :.:......>"::'?>~I.\~~,..~....:} ~ ;;,"-.",:, ~ _.' .,J." _+.. .... l' .."I-. .:.,: ) ':,_t:....: of . ,. 'I. ' {-. .-~. -.' , -.'\ " J.;-":" r,'." " , ~. ~+ l' ~,''''- i ,. .' :- ."-:::'~ \;;:;,... ..., .~, .. ',-q, . ~ -. .'!\ . . :".: _'1, ..\l .... '-\'"' ';"~,-.:... .~::J \ .-;:'/4.~~}~ ,,:' ~i , .~ ....r.~ '"1";,,.:, ,:4,.':~<: ., . ( .. :r\ """'>' ;. ]" .11\ ......-.. .. -_....;.t'"....~, " 5- ~J . \ ,. . , .~ '. 'l :' ~ '. ".,,",j~ '1'-.~ .~~;L\~~;:f~~~C,: .i,~.. . ,,', . " \ ' ,- . .::;::.,~\.;), \':1 " . ':~.. "-..-.~~.~~.._.~..~- '. . .~..-~~' . " ,.~ ),'~1.-'" I.;'.:;~ '.-, .'C',' _/ imow Jf~,m~:l.l:; UP. ii::n .~,,:: ,- " ~ :J,r.l';rz ::'!1T l\10fFI Cl3.SH,1:''::'-:: ~. ,'~" 'OT~~;;!'tTflAq]G "l"i:_ :' .... . .~ICI}03?' Jh;Jli11b:'J3 .30fl3";I"C'" .':; 'I.: '" ~ <'"~ .1,: . , -.~.., ...,...... , . .:~" .\~ \~-,~..:\~.\~-, . ., '-I.: ~ ....,- .' .... ?~>,;~J:~..<..~,.~.7" .. -; 'r .' ~, ';" ' - , '., ......' . . . .~..-'..- l'.t ';' ~ . 1- ,~ ~. , . -'. -.-.-....- ~ '~-'. - . '~"''''''.... .~.. ...~. . - .. " " , " < ' '" ':':" , , .'.." ; ...1 . '. >: . ~ . J. .' , ,,\ " . ... ." ,'~. l ". ~ .. ':/1)"':' l .. " , "1"1:"", 1 , , , ::~i. ii':A" " I :'..Y:l' ...., /T'J/'~',;,' .' ~". , '1' " " , " ",' , , } " r NING & COMMUNITY DEVELOPMENT ACTIVITY INFORMATION 0HEET , kme county COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED! . 1 ,,\/py-y.;p, lJep 6J;U'/Ams PERSON MAKING REQUEST /lJ.IS- J-/a..'r'~o__ [J'rI\Je:" , MAILING ADDRESS SPY'! 'rvai./~LjJ 'OR v CITY) , STATE ^ s-j-ejrrle Oee 4),UIAYVlS PROPERTY OWNER ~ MAILING- ADDRESS 971/77 ZI P CODE ~ CITY S'IAlt: ZIP CODE BUSINESS TELEPHONE # , ? r; }-:3 17) HOME TELEPHONE # BUSINESS TELEPHONE # HOME TELEPHONE # 2" PROPERTY ADDRESS (IF DIFFERENT FROM MAILING ADDRESS) ,3 MAP & PARCEL NUMBER (REQUIRED INFORMATION) , (from,tax maps in Department of Assessment and Taxation or from tax statement) , tOWNSHIP RANGt 'SECTION TAX LOT(S) OR PARCEL # ZONING i TOWNSHIP RANGE SECTION TAX LOT(S} OR PARCEL # ,ZONING , TOWNSH IP RANGE SECTION TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP: 4 SUBDIVISION (if appl icablel TAX LUllS) OR PARCEL # ZONING ACRES , LOT 2. BLOCK' 2- j., fl ""'10 uJ/-H. flJI'(JJ )""/../,, R. if (" c, P IjJ~jlO"~ e:.x I ,~..;... INJ rn 11 /., " LP I 5 REQUEST (state exactly what you plan to do) 6 DIRECTIONS TO SITE: ,SnuJ-t., ,:) tv) , I IV :;'"Y'j P/fJL,j ** FOR STAFF USE ONLY ,** - -- . IJ' NUMBER DATE ...., '" (/) ZONE/LAND USE: BY: DATE: . -t , r-: TIME IN: OUT: ' I(')Qq ~ 71 /I~I-I,RO-11 - , , , ~_._..,..".-...: . i,.' ":'t, .,' . " FLOOD~LAIN~1ArJAGEMEIH ' Milnagement/l,25, East 8th Ave., , 687-4,357, By, (;, 1\1\ c.. Eugene, Oregon: 'Department of Erw,ironmenta 1, " ' , ,Date To: 1'-- Ie,':" e>?', , . ' '.,.' --, "f , , [j Perinit Process i ng Permit No. , O'Planning ,,' P'1rtitionN.o, d P~bl,icWorks Subdivision No, Appl icant, Name SH~cl?lZ\E"_"bl:;,'E=..' '10./1 LU bJ.J\S: .,Address of, site \~'1~ Hc.rz.~1Z. tJlZI..JE- ~11Jb.t=1I=!..t:), SFD AG ~ ADD, COMM, :, S -p.,~ (')12 . . . . Approximatef.lood.hazard study ar'ea,; extra precautions may be appropriate to as'sure that the building' sitewHl be reasonabTy'safe from flooding, De~ai1 ficiod hazard 'study are~ ~ " . Data' Source' ' ' , Mohile' home 't i, e, downs r~ii~i red,: " ' ~uDstariti~l improvement," ,,' , , Site ,in reguliitory Jloodw'1ychailn~l, bJilding prohibited u'nlessi:tis demonstrated tha('ttie, cumul at'; yeeffect of p~oposed."devel opment wi,ll not increase the base 'fl ood'at any: poi rit: 'Contact :Floodplain Management, for 'more, information. .,' ' "," ,.'. ' ..' , " ,.' ;, o BASE FLOOD ELEVATION+, l' = 4100.. S '(t1SL)., '-CeF-t~i"f-i,Ga-t-i,on-a,t-or-above- ,th,i~s-'e,],eva,t;,i'on"'r-equ.i'red~as-Ghecked..be.l,ow,._,' '; " ' ,[2g , ' OTHER'i=~ "E-u=.'-lA...\\ot-.lc.,~~Lb' 'O~~T LEA-coT ~'E:.~E. " " '. Rn.Jo.LE:.'Il:;;;lZ.' \ "'=> ,1..lr1T 12~\\ \Z.Eb. *?:*.*'I!~*.*,**,**.****~**************~*.******-*.****~***.****~***"!!***,**"!t**..,.**,***********-I!***********'!t*********, .0 ~, '[gj .' , [J ',.0 ; :';-' o .'CERTIFICATION,OF ELEVATION " , , a Registered Profess ional " \n the,State of Oregon" :do here~)( . _ C" ,- \:~ ~1, - ~ .~.. '. certify' to Lane" County, tha't the fo'll,owing 'el evati on represents a, ,survey . " . ~ '" " ~ . ,. , !)lade ,by me or under ~->: supe:,vi si?n: ./.\,' , ", . ,,/, '.: ,q,l:he~oun,d'ation elevation (includingbasenient slab); " 0, fhe ~~ound eleva:ti~n that structure wi(ll?e pla~edon = ' o The!firs'tfloor-elevatiori =' " (MSL), o The' e leva'ti ~n o( ;~e ~op o~ !l oodPro()fing,= ' '0 Other, ., , ' !, 3: '" "0 -:" P \ ,,'(r~SL), ~. .., (~lSL'" , I J '\j I )J I \J c . "I>-, , , '(MSL) .' , Reference , L9ca ~fon, Bench Mark No., , ' '1;'1 , Sign~ture Date, '...... SEAL . r -,j, , .... " 'O,rigi.nal to be certified and returned to'Larie., County FTooqpl a in" Management , lstcQPY' wit~ applic~tionl;nspedion 2nd 'copy t6applicant , 3rd copy to Fl oodpl ai.n>Management , ~ 4'; &,~ ) 'c,h, () , if'/"/'()'I"" ; ':.'~-" ':, '. ff. "l.' . t '.s;"',:~,:-:;~' v: ,I' .1': 'f~~ "';"",- t' ,-./.- '-I.... ,," . ,'.r ,A r ~, ,,", H , , / Iv I) I" . , ' J J. I .~ , ) lrl.' " I. II j L.ANE APPL.ICANT WI~L.IAMS, SHERRIE TLI 1803023200300 SUBDIV NEW BLDG TYPE MH USE R BDRMS COUNTY DEPT ENV MGT RECEIPT I 7583 DATE 011983 ~DDR 1475 HARBOR DR., SPRINGFIELD; OREGON , L.OT .BL.K IBLDGS 001 PHONE 747 3777 - \ ,J j 3 UNITS 001 $TORIES ADDR ~CTION ,DESCRIPTION I SQ FT UNIT COST VAL.UATION OWNEf~ NME CODE ' APPL. NO BP, " I'll" , BP I'll" ,II '"BF' MH I...C' 7~;B~~ MH MHPL NO. FIXTURES: t1ECH S'UH PCI< SDS SUH FP NO. SDSC CONNECTOHS: MECHANICAl.. FEE STATE SURCHARGE PLAN CHECK FEE 15.00' EAC:H .... FEE DAY': 4% 0% 1.>2..50 10.00 ' 2.90 ,50.00 5.00 10.00 \: ~I CATG: ",1"1" HA FP SDS SI pCI< OTH ISS .... SEQU: 0 0 I 2 3 II TAKEN BY Rl..H EST. COMPLETION I)ATE TOTAL FEEH' 140.40 CK TRS, TL 15-03-02.32' Job Location (Address) (475 .M ::50l ::Permit II Plo~, Plan :::~~ ~ Subdivision -rut:efL G-rOue... Lot Z Block Z- ~ JP 1~-S~ " '\"'''''' ~ 'S:+Oyo.'le "'B('cA -~\ c.1A y f O'(-t- (~bo-r D'V'I ~ For For For Permit II Permit II Permit II For For For 9::', ';;;./ _..----.-..-- ~f \ \-::F~~ "-. --..... \. :;., , ' \V' L.I ~ (N(;. RbO fY) ',I ,,--JclA'I~rJ \ I .4-'" ,/ ~ "", :- <::::! ~ ( p r (' ~ 1\' , " ")'1 - ,\/ ------:---- yY\ 0 b',llL Home.... I" I ~ - (----7 j\'P \ " ':l ~;;;., S'/~ '0 ~ '" /\ " , ,~ ,/ I \ Vicinity Map ~ N' C74-150 " _..' ......---.. -~ '~";'.r,,-;............-... _, ~.""" -~:'~:"""",...-.....~.\,;,,..~-Q:f";""-.,..~'~'~':i/"".~ ......~~,'~~-:.!"_,....:~~.~, 'VI...... ,.'..- . --J. _.v..,.._,.,'::-.::.:...J-__"-. :..........~.,_.j,,_";.~.. -':,..__-.-.........,..:..':'-..... -.". ....:.~.- .~AM~'(PLEASE' PR~NT;' ~;.2ATIO~~RI~ATION PERMIT II '1 q-'i)3' "'""'" /47$ ~!d'M~~~4~ 9'A"r? 'APPLICANT (') ,OWNER ( ) CONTRACTOR (') / ~" - ../ 4P r-' (.,/ ";/.1', ,'.#" " REASON FOR, C~LLING' PERMI~).oR APPLICATION) :: . {:~A-/.-d' c:J P 5', /ff/ -4V~~ -4~C~~A[~hd~y~/~/?~, ' SIGNATURE: DATE ' /~/'7' - r Y FEES PAID ,FOR WASTE DISPOSAL SYSTEMS (SITE INSPECTIONS AND/OR APPLICATIONS TO INSTALL THE SEPTIC ~ANK AND DRAINFIELD), ARE ORDINARILY NONREFUNDABLE,' SOME REFUND MAY BE ON 'THE BUILDING, PLANNING, OR PLUMBING PORTIONS ACCORDINC'TO THE AMOUNT OF THE PERMIT/APPLICATION PROCESSED. ' " AUTHORIZATION FOR POSSIBLE REFUND:' r~ - cL... n i), : % BUILDING PERMIT FEE $ % MOBILE' H0I1E FEE' $ % PLUMBING PERMIT FEE $ % PLAN CHECK FEE ' , $ % STATE SURCHARGE FEE $ % SEPTIC DISPOSAL FEE $ ~ 0 c.. % SITE INSPECTION FEE $ % LAND USE APPLI, $ % PPA OR NPA (PLN 'AMD) $ % PRE~APPLICATIONS $ % RECORDING FEES' " $ % PARTITIONS ' $' % COPIES & ORDINANCES $' FOR PROCESSING FEE $ ~ $ ~O. " MINUS $25.00', \ , i, > ,: '-',.,.'~ 'SIGNATU~:b~ C2Z)4'--:X V TOTAL AMOUNT TO, BE REFUNDED DATE /7' ~'2'-? /7' TO DEPARTMENT OF FINANCE: BUILDING PERMIT REFUND' $, STATE SURGHARGE REFUND $' SEPTIC DISPOSAL REFUND $ ""f/ //. ,,-~ ,SITE INSPECTION REFUND $, LAND USE APPLICATIONS, $ PLAN AMENDMENTS, $ PRE-ApPLICATIONS $ REGORDING FEES $ PARTITIONS $ COPIES & ORDINANCES $ TOTAL AMOUNT REFUNDED $ 24-98~74/ACCT 42120/PROG 041 ,Receipt # 24-08-74/ACGT 42124/PROG 041 Receipt # 24-08-7,4/ ACCT '42133/PROG 043 Receipt, II!")/') '13,t;/} 24-08-74/ACCT 42134/PROG 043 Receipt # 24-08~74/ACCT 42150/PROG 035 Receipt #, 24-08-74/ACCT 42150/PROG 013 Receipt # 24-08-74/ACCT 46202/PROG,034 Receipt # 24-08-74/ACCT 46210/PROG 035 Receipt # 24-08-74/ACCT 46202/PROG 035 Receipt # 24-08-74/ACCT 44419/PROG 034 Receipt # 4t2 t.!:- :::SE':a;~;~~L~~ / ADDRErs /~7s ~~A. -f~laY4~ ~/6fJr/ ~7f"7? , ' " DEPARTMENT OF PLANN. INr0 CO~.rTY DEVELOPMENT ";-;7 , , COURTHOUSE/PUBLIC'SERVICE BUILDING &/" , 125 EAST 8TH AVENUE, EUGENE, 'OREGON 974,01 . '-:J ,:.;;~;;~'~, ..~'-'~- ~:'~;~A::~~}~~~~:~:'AU~~ORI:~:~~~'''~-:E:'~;:;~I' ;}[51 ~ ;;(5 N~E (PLEASE PRINT) -S'h"rv-',l'" J. F ,.1. (,), {{ '~A'VnS .::..i........- . ADD\<ESS /<;7.s- If AI'! i3 oR () t? III f' ; $;;p r- /IVO r=:; elrJ () R APPLICANT ( ) OWNER (\,..)? CONTRACTOR ( ) J ,/ REASON FOR CANCELLrNG PERMIT (OR APPLICATION)' T j, p ( _ rJA IV 1l) P 1.IPY.P q'l Y71 , Llf':J ,-f/^') +Il /'/1 rk' ;:::rl"" +6 Qrl -Ii, ....:nu Q t, d,') tV/lT mAkE", /-1-. r,),:> /, n J. \ J, J , -'111+ r,~ Lid) ,^'a A I'Ylnt..,L'P ArlYne",' SIGNATURE ~..:.....I ./)-1'",- (~j, ~tl. ..: ........., ,DATE /.)..-/ '7-0" ~ FEES PAID:FOR WASTE DISPOSAL SYSTEMS (SITE INSPECTIONS AND/OR APPLICATIONS TO INSTALL THE SEPTIC TANK AND DRAINFIELD) ARE ORDINARILY NONREFUNDABLE, SOME REFUND MAY BE ON THE BUILDING, ,PLANNING; OR PLUMBING PORTtONS ACCORDING TO THE AMOUNT OF THE PERMIT/APPLICATION PROCESSED, AUTHORIZATION FOR POSSIBLE REFUND:' I % BUILDING PERMIT FEE $ 4,()'Jg..,/ fa ')..;::0 % MOBILE HOME FEE $ , Cl.O '1...11 It' ,,;.0 % PLUMBING PERMIT FEE $ - I~/ . % PLAN CHECK FEE $ l.~ort/ 'J ,qo % STATE SURCHARGE FEE ,$ ""U lin;. k ..,.r..r.1'.1.l. Ul..;:,n.J;:'R.L "1' r.,n '? J, ,g-rE, IN[>J'ECnON FEE $ --'-7~rV -~ tAND'nsP*'At>kI. $ % PPA OR'NPA (PLNAMD)$ % PRE-APPLICATIONS $ I % RECORDING FEES ' $ JO'2!::!-/ O%J % FbI'fJf')1SP't./f'l~ $ % COPIES & ORDINANCES $ MINUS $25,OO'POR PROCESSING FEE $ q) , t9t'l <7: / ?rO ~7/d1~~R~B ~~~ ~ {~~~"L,/" . , .' _!'<~ ,/' 'f1 j!f;// ~ ....,,),:/t,.v' ;J ~'V, c---. j ,I?j"'-' , 'A' A 'C1~i;- '/ '':''' .;1 . , , h 17 [~ ., .~:..-} l?1 / j/!1 ') ,F .'1 V L . t,. ':J..,'fO ~!t9 "tVl '-'."" ,,~ v, 00 0' . . . "'35'- Y'b{L: $ ~'$ rl}~ I/, -J.?J14 /- :t-o ~5\ 1"" '" TOTAL AMOUNT TO BE REFUNDED ~A.^ <. ~ :II' ? dl:' 3g- c2, CjIJ SIGNATURE DATE TO DEPARTMENT OF FINANCE: BUILDING PERMIT REFUiW$ STATE SURCHARGE REFUND $ SEPTIC DISPOSAL REFUND $ SITE INSPECTION REFUND '$ LAND USE ApPLICATIONS $ PLAN., AMENDMENTS $ PRE-APPLICATIONS $ RECORDINC FEES $ PARTITIONS $ COPIES & ORDINANCES $ 11#$d' II -t"3 ~t::7 II II 1/ II II II II II 24-08-74/ACCT 42120/PROG 041 24-08-74/ACCT 42124/PROG 041 24~08-74/ACCT 42133/PROG 043 24-08-74/ACCT 42134/PROG 043 , 24~08~74/ACCT 42150/PROG 035 24-08-74/ACCT 42150/PROG 013 24-08-74/ACCT 46202/PROG 034 24-08-74/ACCT 46210/PROG 035 24-08-74/ACCT 46202/PROG 035 24-08-74/ACCT 44419/PROG 034 Receipt Receipt Receipt 1i."eceipt Receipt Receipt Recej-pt Receipt Receipt Receipt ~S:~ $ TOTAL AMOUNT REFUNDED PLEASE MAKE CHECK PAYABLE TO: NAME /~~ ()t,~~ ~~~ ADDRESS /7L 7.~~~~4~ _hg'/~~ ~~.J , DEPARTMENT OF PLANNING & COMMUNI):-Y DEV~~OP,)lENT ,/ ~//q"7 COURTHOUSE/PUBLIC SERVICE BUILDING ~ ~'././ 125 EAST 8TH AVENUE, EUGENE, OREGON 97401 ./ .