HomeMy WebLinkAboutPermit Mechanical 1985-08-08bneccr-rty
ACTIVI'I Y INFORMATION ST,EET
COMPLETE IHIS SECTION. INCOMPLETE FORMS t.JILL BE REJTCTEDI
** FOR STAFF USE ONLY **NUMBER
DATEZONE/LAND USE
BY: _DATE: TIME IN:
-
OUT:
4
,(,(ll
I
? 7*
5
7u7-?5 7
E
ffi /_L1_EJ2;_
HOME TELEPHONE #BUSINESS TELEPHONE # HOME TELEPHONE #
2 PROPERTY ADDRESS
( TF DIFFERETT TnO
(from tax map
or from tax
s in Department of Assessment and Taxation
statement)2I ffi ZONING
m[Nsmp 6NGE mTr[N ffi ZONING
MINSHTP N-ARGE SEETTON ffi ZONING
TOTAL CONTIGUOUS PROPERTY IN SAME OI,JNERSHIP:ACRES
4 SUBDIViSI0N ( if aPPl icable)
3 rvrae 6i PAHE EL NUMBEFT
( REQUIRED INF0RI,IATIoN)
5 REQUEST (s:tate exactly what you plan to do)
t1 3 2s,
TOWNSHIP RANGE SECTION
23 oc
LOT BLOCK
t*
e*,
J.
9.pr-.r*-r-T0 SITE: I
LAe&LL\".r il,*r*a6 DIRECTI
r-fl
16.,4wrr
LAND MANAGEMENT DIVISION / 125 E. 8th AVE., EUGENE, OR 9740I I 687-4061
ilu! ycq q(l u rv,Hatrnr. 5c( oN\a M
PROPERTY OilNET-
I l' t
MAILING ADDRESS
PERSON MAKING REQUEST
2t ?
t4
*AXu 0r*" "l,,+LA
I
i,.
Z
TRS#ll-o 5-'7{'z'I +77 DATE ISSUED:PERMTT# /?4 7'As
Ot^tNER,S NAME PM
CONTRACTOR'S PHONE NUMBER
BACK REQUIR
FRONT
S
SIDE
# PLUMBING FIXTURES
I NTER I OR REAR
K THORI SDS APPRO\IAL REQUIRED
SiTE ADDRESS
F00TrNG / FoUNDATT0N trApproved Date
/MOBILE HOME PLACEMENTf] INSPECTION
Correcti on Date Insp ector
PLUMBING GROUNDWORK INSP ECTIONApproved Date Correcti on Date Ins pec tor
UNDERSLAB PLBG. f] /UNDEApproved Date
RFLR PLBG. E INSPECTION
Correcti on Date Ins pector
OTHER INSPECTIONApproved Date Comecti on Date Ins pe ctor
ROUGH PLUMBING (TOP OUT) INSPECTIONApproved_Date Correcti on Date Ins pe ctor
FRAMING INSPECTIONApproved Date Correcti on Date I nspector
ROUGH MECHANICALApproved Date Correct'ion Date Inspe ctor
iNSULATION / VAPOR BARRIER INSPECTIONApproved Da te Correcti on Date Inspector
LATH / GYPSUM BOARD INSPECTiON
Approved Date Correcti on Date I nspe ctor
Approved i,,/ Date orrectibn y' ou te nsp ector
FINAL PLUMBING INSPECTiON
Approved_Date Correcti on Date Ins pector
mrLDrNG D /M0BrLE HOME [] /AG PLACEMENTI]
Approved IDate Correction Date_I ns pector
M74-L97
proved_Date Insp.
Tr-CERTIFICATE OF OCCUPANCYtrApproved Date-------lnsp.
PORARY CERTIFICATE OF OCCIJPANCY
SE
C1
,w
4,.gwJr-
t*r-{*
(-,
rb',p
}r"
ril 6r"I
/
*
L_
/)fr
-t-.-------
i
I
I
/
-)7)
I
t a 't
l?-,r-,