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HomeMy WebLinkAboutPermit Plumbing 1979-9-28 . .' ~)f\ r~1 r , ~?t~to, ?>r,-~~'fl Application for - !/~"" ~. Dec~ ^ ,lotrfr-o.v I Structures now. on the properly - ~ bl", . ~JI r;/J' 'l2:11:! iRii!!pli~!1lIi(!~~!i&~ip'mlP~!iiy\i ~ ig~~!Ii~~}"l~li 0 COnlll~lWial . 0 () Affidavit: I, 'i3a-troJ-<'):iJJ.liitif!{{;i{iJV"'Rt2.-d.,.~ , hereby certify that this. information is true and accurate. If this application is for an agricultural building it will be used for purposes allowed by the State Building Code and Lane County Code Chapter 10 (zoning) and for no other purpose. I have the following legal interest in the property: J<:' owner of record; contract purchaser; lessee; holder of an exclusive option to purchase; duly authorized to aetfor the owner, WhO. is. ~cnowledgeable of this application. ~ Signature/Address ~.-'.&~~~~k-. .j/~O /~ -Izt.e,v Av-e . . zip) 97Y77 . Tele~~ - I or Date j' ~hen permit ;s ready notif.Y: /::/ Appli.cant IX Owner ,./~; c?ntrac or !>J:.: C/ mail C/ phone Owner _'R~ YI1t:TWI?-&..d'f'P< 1Lt/A>l:.....-h.k)' ~ ~6-Tzip) 17'/7 '1 Phone ?CJ'1 9'1'9'/ Contractor ~..::.e,... Lp.",<;;-!. / (zip) ~ 7Y177 Phone ?<t 1 7'1<?1 Contractor's OSR# 1'irt.1f3 Plumbing by DEPARH1ENT OF ENV IRONi1ENTAL r'lP.NAGEI~Et-lT PSB, 125 EAST 8TH AVENUE EUGEI'E, OREGON 97401 ,/IF \r -- ,,/ , ~~~~~~~ ...--' '- If Commercial: Reside-ntial: ~ UO NOT WRITE BELUW # of employees . \ . holes readY\ . IHIS LINE <"" ) u:::::. c'::::\c.....(') Valuation Fee $ LX:X..J $ / $ $ $ each $ each $ ~ r-,-r." r. ro. f' P'....~ ~ ~?~ u ~\.O~,..:::'.~ -\ d.. . '\-::::::'c:. ~"'- . . <--::-.~ O..'.........M8~.....,.............'..............'..........,.........,........'........'.....r. ' ~D~ E1$!!ij~R:* . .!.-J Receiv~di,y- \. )X\n.A-... .... (d .J ('<6l ) , BP # G\:\lc C-~e. d '---::::1< - \. ~ . ,,,\-I. \0 \-"'.......\ SI test " ,. Fee' COd" pe$Cflotfcin I >\., .....:: : PERMIT PROCESSING Minimum setbacks: zonOl-. y Pa~ - 't, front ( . ~\' ;,\, side " -) ~ ...../ Parcel # $ $ $ $ $ \ ()~ _ . ..\....\:.~ ~ i i.nt.~reC~) Subtotal - 4% State surcharge Plans check fee Change of Occupancy '\~ Water Supply Proposed Year Installed Exist.ing TOTAL Comments To be typed on permit By ...U'\ '\ Y " Date ~- \.1\ .'\~ Group M Fire Zone"7, Use Classification. ~~"" ~ ~p,.. ~ _--:/~/11~~ ~1 v?~ . I CP&I Typee::-N To be typed on permit I . By It. 11. i \,.c; 7~ Date j-VT/,/.:t For plans informa~io~ ~11 (area inspector) . ~~.J'-.--.... Phone,,? /,?" ~ / DlrectlOns to slta~"" c'-_ "- ~ \( '\..0, y"\ -' '\ ~"\C'lJ ,~ ~ ~c:L, \0 --....,,., ~'Y~ \=<.~ ~ \ 'S-+ "L. \ G"\". ~: "'-.+ . ~/ S 0 Plans to. CP&I _ setls) Date Hold Sllp Date ~ Date to -~ WPC ---c- set(s) Required to PCC Completed PCC I CP C WPC - - 9/~ /~/ Planning C/ Pub;;e Works I]{ Elevation "ft; n/a 9..?::2-.6:.... C/ Address ~ /~I Facility Permit ~I Environmental Health '1/7d ,vlO ! 01\! FOR INFORMATION about progress of your appl ication call: C74-171 Permit Control Center 687-HELP (687.4357) . PLOT . YI--/JtI Vie"", {r YJl? rv1,4' IV S 1"" 'S ,,;?cdf, !- .' '" ~ , J G- ~ "- J - -::..'.. ''-~ , . \T>M1:0t.- iZ. 0 I ' ..:;:"-., ~ ~ " ~ /'& -0 2' 0(, -.350( \ N <IF- J23~ ~ ~()J'Frct.0 !'- 1 N -J '-------.:.. ------ ~ I MOT ''''-3?J'1. I::ec.".-J ?iZOPOSC[) G-/TRA6E "-~;;~;?-'.:". '~,.. .1' " ":/__/ h . x' ~~;,:;/:':<.:~< :e'!,\/5T}IV~ ' //"", , " , f{i),m =- ~"~/i':' /))/: /,..,' , <;.'., . :/ '.;/ )::.'. /:<....:. ,//././" , /,? 8 /,.../ ' .,.' ,/ /, .,/";' '..' '/.'/'.<>', , , /,' ,. :.--<.,,>.., //;/ , ~ v . ;...." '-,;-._. - .-:.---~.. ..,'" -. ;""-. k,NiZl.-e Y AVe ~ ~ 20' . . ~:':~ti1. 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