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HomeMy WebLinkAboutPermit Sidewalk 1992-04-01l<Eb llJ ENI AL 5 IDzuALK AtrLICA ,<C,I ALffi,,,Tto{ /F'Efr/7 siPFT'A,G F,ELD Jots ADDfr,o& I obo l..tOAf }\ lYl:g1 499E990R9 l.1AP NO.t --t -03-35 |L TAx Lor No.7?-oc> 9uBDtvlStor.t:C,t--r.C-rc +, oUNER N-Pa.ED ADDRE99: I O3() 5TATE: O0L NOAIA -)-r s Af5C> c\A/ 86 CITY: SPFD ztP, 9-?+11 PrtohlE NO- tIJcRK REcEtpr No: q_lB-) CASH cHEcK L'/ * CHECKED FOR DELNAJENCIES No ? SIGNED: DATE, f>r-- 3e*,* 4 -r -92_ UJoFK TO EE PEE€FHED EY' ouNER "o111p,acToR* rL. L, sc!\rw-r-r REGrerRATroN *r.*44 Lz-l EXprREe, I -zz-2j CURB-CLT: RE9|DENT|AL _ coHl-rERlcAL SECOhID DRI\€IUAY ( gEE TRAFFIC )REAUIE9 APPLICATIo|! rcR A SECOi{D DRI\€IUAY(T-4,IA)OR A C.2IJNTY APPLICATION rcR FACILITY PERI-IIT (C AA.2O3)IF IN Tl{E UG.B. DATE OF APPLICATIOhI 4 -l -?z- cuRts gtDE _srDElJALt< t/gErelAcK -_ ADDRE39 PuoNE: 7'l +*BCE{- PFOCEDI,IRE FOR IN9FECTICI.{ RE@tiE9T: 3ALL 12b-3163 (RECORDER ) 9TATE YorJR crr.r DES|GNATED JoB NLJI-i3EB Jo3 ADDRE59,TYFE dtN5FEcrlor.l REotlEgrED AhlD tu{EN You IJILL BE READy rcR NgpEcrtor.t, ianieaEroes oe our.ees NA:.IE ll^.tDPI{OhIE NI}1BER REAUESTg RECEIV€D EEFORE IZOO NI IUILL EE I'1ADE THE SA'1E PAV, REGiJE9TS /fJIER1Z@@AI,l UILL tsE MADE TI{E NEXT III2RKING DAY EXIgTII.IG ELJILDING PERIIIT NO. ( IF AFPLICAELE ) *YOUR CITY rED JoB No. ,sf 9zo9z IgEE BOOK reCU|RED ]NgPECTIOI{9 gIDEIUALK / DRI\GIUAY FOR ALL CONCRETE PAVING TIJITI]IN THE STREET RIGHT OF IIJAY, TO BE I1ADE AFTER AL EXCAVATIN6 19 COI.IPLETE AID FOR!.1 UJOFA< IO.ID 5Uts-BAgE T1ATERIAL 15 IN PLACE CU@ / APPROACI{ APROri.l' A.FTER rcS19 ARE ERECTED BUT PRIOR TO FOURING CONCRETE. FEE9, glDEl,UALKg cuRB-cuT uJALK X, TOTAL PEFI'1IT FEE:1 t2.25 r1@.OO + *O.lb/LF. ( X ) 15 OF UALK tlO.OA+*O.\b/LF.(X) COII'IT1ERICAL DRI\GI,UAYg SHALL HA\G 5'TO A'FLAIRg3'. @'gTA{DARD I i-,IA\E CARERILLY EXA'.1IhIED THE COI1PLETED APPLICATION FOR PEtriI T, A.ID DO I-.{ER=BY CERTIFY THAT ALLINFORIIATIC,I-I I{EREON 19 TRUE AiD CORRE CT, A,NID I FURTI]ER CERTIFY TF]AT ANY AND ALL I!OR< PEEO 1EDg;ALL B= DONE IN ACCORDANCE IUITH T+.,IE ORDINANCES G TI{E CITY tr SPRINC#IELD, AND Ti]E LAI.I]s G T+JEE?A OREGON PERTAINING TO TI]E IIJORK DESCRIEED Fi=R=IN, AND THAT NO OCCUPA\CY UILL 3= I-IAD= THE BUILDIN6 DIVISION. I FURT}IER CERTIFY TI{AT ONLY CONTRACIOR9 rutTi-{ oR3 10105> rulLL BE u5=D oN Tl-115 PRoJECT. G gTRLICTURE IUITI]OJT PEB1I ft - l-= B /\ u- / -7?