HomeMy WebLinkAboutPermit Building 2015-10-09*,F$lr!uGFr*nLf,,
225 FIr-rH STREET . SPRINGtrIELD, OR97477 . PH'(541)72G3753 o FAX; (541)72C36E9
ADDRESS REQUEST
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Property Owner:
Mailing Address:{l"naS (ovt&&- Ub,S Fol\o
City:EOL<Q-'JE
Person or Agenry requesting address if other than owner:
State: e@o^t Zip'nl.+oS
Phone number where you can be
contacted between l:00pm and 5:00pm:g.Llt 45{+ 461{
Assessor Map #;tg-03-03 -t+Tax Lot #: 2ool
Properties are generally assigned addresses when application is made for a permit to
improve the property. Please explain specifically why you need an address assigned
prior to the property being improved:
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Proposed Address:z2n5 *uq+s wAY
Property Owners Signature:Date:to' n -U'7
516- aqao-twrfreei
Date Received
'7d)#:
Reference Number:
Approved
lf approved, new address is:
Received By:
Amount Paid:
Tax Lot #:
Denied
Date:
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Shared Drive(T):/Building I l-02.doc
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Reviewed BY:
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