HomeMy WebLinkAboutPermit Demolition 2007-06-04Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37 69 Inspection Line
Building/Combination Permit
PERMIT NO: COM2005-01399ISSUED: 0610412007
APPLIEDT 1010712005
EXPIRES| 12t0412007
VALUE:
SITE ADDRESS: 1112 21ST ST
ASSESSOR'SPARCELNO.: 1703254302600
PROJECT DESCRIPTION: Demolish house and garage
TYPE OF WORK: Single Family Residence
TYPE OF USE: Demolition Residential
PhoneNumber: 541-485-9523
Springfield
Owner:
Address:
Contractor Type
General
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
CITY OF DESTINY CHURCH
I14O N 21ST ST
SPRINGFIELD OR 97477
Contractor
CHARACTER HOMES OF OREGON LLC
CHARACTER HOMES OF OREGON
Type:
Type:
Energy Path:
Sprinkled Building:
Overlay Dist:
oN:o\
rs$
rcture:
License
159710
159710
nla
Expiration Date
0412612008
04/2612008
Phone
s03-472-0723
503-472-0723
Lot Size:
Sq Ft lst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
Downspouts/Drains
Notes:
Paee 1 of3
I
# of Udits:
Primary Occupancy Group:
Secondary Occupancy
Primary Construction
Secondary Construction
# of Bedrooms:
coN t RAC t uK rN I tl$!!!!!l!..1
0s
Lrt,YlrLurrylrll\ r rl\ryJ
toPaved
bY the aIe set torth
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-7 26-37 69 Inspection Line
Building/Combination Permit
PERMIT NO: COM2005-01399ISSUED: 0610412007
APPLIEDT 1010712005
EXPIRESz 1210412007
VALUE:
Description Type of Construction
Fee Description
+ lloh Administrative Fee
+ 7oh State Surcharge
Demolition
Sanitary or Storm Sewer Cap
+ l0oh Administrative Fee
+ 57o Technology Fee
Renew Building Permit
Renew Plumbing Permit
Total Amount Paid
Total Value of Project
Date Paid
Value Date Calculated
Receipt Number
120050000000000r478
1200500000000001478
1200500000000001478
120050000000000r478
1200700000000000684
1200700000000000684
r200700000000000684
1200700000000000684
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Amount Paid
$9.00
$6.30
$4s.00
$45.00
$4.s0
$2.25
$22.50
$22.50
t0t7t05
r0t7tos
t0t7tos
t0t7tOs
6t4t07
6t4t07
6t4t07
6t4t07
$157.05
tr'ees Paid
Plan Reviews
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
work day.
Demolition: After demolition is complete, sewer is capped or septic is pumped and filled and inspection is
requested and approved, and all debris is removed from the site.
Sanitary Sewer Cap: Capped within five (5) feet of the property line and capped with an approved material as
required by the code.
red Insnecfions
Page 2 of3
Valuation Descrintion I
Status Issued
225 Fifth Street, Springfield' OR
541-726-3753 Phone
541-726-3676 Fax
541 -7 26-37 69 Inspection Line
Building/Combination Permit
PERMIT NO: COM2005-01399ISSUED: 0610412007
APPLIED: 1010712005
EXPIRESz 1210412007
VALUE:
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCy will be made of any structure without permission of the Community Services Division, Building Safety.
I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I
further agree to ensure that all required inspections a re requested at the proper time, that each address is readable from the
street, that permit card is located at the front of the property, and the approved set of plans will remain on the site at all
times construction.
b
Owner or Contracto ature Date
Page 3 of3
225 Fifth Street
Springfield, 0regon 97 477
541-726-3759 Phone
Cif., of Springfield Official Receipt
D ropment Services Department
Public Works Department
RECEIPT #: 1200700000000000684 Date: 0610412007 2:39:08PM
Job/Journal Number
coM2005-01399
coM2005-01399
coM2005-01399
coM2005-01399
Description
Renew Building Permit
Renew Plumbing Permit
+ 57o Technology Fee
+ lj%o Administrative Fee
Amount Due
22.s0
22.s0
2.2s
4.s0
Item Total:$51.75
Payments:
Type of Payment Paid By
Check Number
Received By Batch Number
Authorization
Number How Received Amount Paid
Check CITY OF DESTINY djb t0t2 In Person $51.75
Payment Total:
-$Sffi
cReceint I Page I of I 6/412007
*sn}$r*Frslsr
CitY of SPringfield
225 Fifth Street, Springfield, OR97477
541-126-3759 Phone
541-126-3676 Fax
CITY OF DESTINY CHURCH
II40 N 21ST ST
SPRINGFIELD OR 97477
coM2005-01399
1112 21ST ST
Job Number:
Location:
Project Demolish house and garage
Dear Permit Holder:
The Springfield Building Safety Code Administrative Code provides that in order for a permit to
remain valid, the work which has been authorized by the permit must begin within 180 days of the date
of issuance, and an inspection must be requested at least every 180 days.
According to our records, you obtained a permit for a project at 11 12 2lST ST which is set to expire on
l}l512006. Our records indicate that you have not requested an inspection within the past five (5)
months. This letter is written to notiff you that your permit(s) wi1l be expiring shortly. If you are ready
to request an inspection for your project, please phone the inspection line at 541-726-3769. If you do
not request an inspection prior to the expiration date, your permit(s) will expire and additional permit
fees will be required in order to complete your project.
If you have any questions, please feel free to phone me at 541-726-3790
Sincerely,
Lisa Hopper
Building Safety Management Analyst
September 19,2006
City of Springfield
225 Fifth Street, Springlield, OR97477
541-726-3759 Phone
541-726-3676 Fax
March 30,2006
BETHEL ASSEMBLY OF GOD
1 140 N 21ST ST
SPRINGFIELD OR 97477
Job Number:
Location:
coM2005-01399
1 1 12 21ST ST
Project:Demolish house and garage
Dear Permit Holder:
According to our records, you obtained a permit for a project at 11 12 ZLST ST which is set to expire on
41712006. Our records indicate that you have not requested an inspection within the past five (5)
months. This letter is written to notify you that your permit(s) will be expiring shortly. If you are ready
to request an inspection for your project, please phone the inspection line at 541-726-3769. If you do
not request an inspection prior to the expiration date, your permit(s) will expire and additional permit
fees will be required in order to complete your project.
If you have any questions, please feel free to phone me at 541-726-3790.
Sincerely,
Lisa Hopper
Building Safety Supervisor
The Springfield Building Safety Code Administrative Code provides that in order for a permit to
remain valid, the work which has been authorized by the permit must begin within 180 days of the date
of issuance, and an inspection must be requested at least every 180 days.
GFIELD'
Buildin g/C o mbination Per mit
PERMITNO: COM2005-01399ISSUED: 1010712005
APPLIEDz 1010712005
E)GIRESz 0410712006
VALUE:
Status: Issued
225 Fifth Street, Springfield, OR
541:726-3753 Phone
541-72G3676F2x
541:7 26-37 69 I ns pe ction Line
SITE ADDRESS: 1112 21ST ST
ASSESSOR'S PARCEL NO.: 1703254302600
PROJECT DESCRIPTION: Demolish house and garage
Springfield TYPE OF
TYPE OF USE:
Site Work Only
Demolition
Owner:
Address:
BETHEL ASSEMBLY OF GOD
1140 N 21ST ST
SPRINGFIELD OR 97477
Expiration Date
04t26t2006
04t2612006
Residential
Phone
s03-472-0723
503472-0723
Contractor TVpe
General
Plumbing
Contractor
CHARACTER HOMES OF OREGON LLC
CHARACTER HOMES OF OREGON LLC
License
159710
159710
BUILDI
# of Units:
Primary Occupancy Group: R-3
Secondary Occupancy U
Primary Construction Type YN
Secondary ConstructipgTENTl O I'l :Oregon law
# of Bedrooms: follow ruleS adopte dbYth
Notificati on Center. Those
OOSO. You maY obtai
the center.
Frontyard Setbaclc
Side l Setback:
Side 2 Setback:
Rearyard Setback:
Sohr Setbacks:
numb er for the Or
Center is 1
Street
Storm Sewer Available:
Special Instruction:
# of Stories:
Height of
Type of Heat:
Dist:
Trees
Paved Drive Rqd:
oh oflot Coverage:
e-''
Lot Size:
Sq Ft lst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:nla
calling
REQUIRED PARKTNG
Total:
Handicapped:
Compact:
Sidewalk Type:
DownspoutVDrains
}ltffiwr,s-
PUBLIC IMPROVEMENTS
Notes:
tt
l of 3
uuN r r(AU r ur< rN l u$\!l!\
SPRINGFIELD
Status: Issued
225 Fifth Street, Springfield, OR
5414264753 Phone
541-726-3676Fax
541:1 2G37 69 I nspe ction Line
Buildin g/Co mbination Permit
PERMIT NO: COM2005-01399ISSUED: 1010712005APPLIED: 1010712005
E)PIRESz 0410712006
VALUE:
Description Type of Construction
Fee Description
+ l0o/o Administrative Fee
+ 7Yo State Surcharge
Demolition
Sanitary or Storm Sewer Cap
Total Amount
Total Value of Project
Date Paid
t0t7t05
t0t7t05
t0t7tos
10t7los
Value Date Calculated
Receipt Number
1200500000000001478
1200500000000001478
1200500000000001478
1200500000000001478
$ Per Sq Ft
or muftiplier
Square Footage
orBkl Amount
Amount Paid
$9.00
$6.30
$45.00
$45.00
$10s.30
Plan Reviews
To Request an inspection call the24 hour recording at 726-3769. AII inspection requested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m. wiII be made the following
work day.
Demolition: After demolition is complete, sewer is capped or septic is pumped and lilled and inspection is
requested and approved, and all debris is removed from the site.
Sanitary Sewer Cap: Capped within five (5) feet of the property line and capped with an approved material as
required by the code.
leorrired fnsnections
2of3
Valuation Description I
Iees raro l
Status: Issued
225 Fifth Street, Springfietd, OR
541:726-3753 Phone
541-726-3676Fax
5414 26a7 69 I nspe ction Line
Buildin g/Co mbinatio n Permit
PERMITNO: COM2005-01399ISSUED: 101071200s
APPLIEDz 1010712005E)AIRBS: 0410712006
VALUE:
By signaturer l state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certi$ that any and all work performed shall be done in accordance
with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the wonk described herein,
and that NO OCCUPAIICY will be made of any structure without permission of the Community Services Division,
Building Safety. I further certiff that only contractors and employees who are in compliance with ORS 701.005 will be used
on this project.
I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from
the stree! that the permit card is located at ttre front of the property, and the approved set of plans will remain on the site
at all times during construction n I I(+/a^?-of
Owner or Contracto ,s {gonture 'r Date
3 of 3
225Fifth Street
Springfield, Ore gon 97 47 7
541-:726-3759 Phone
City of Springfield Oflicial Receipt
velopment Services Department- Public Works Department
RECEIPT#: 1200500000000001478 Date: 1010712005 11:43:42AM
Job/Journal Number
coM2005-01399
coM2005-01399
coM2005-01399
coM2005-01399
Description
Demolition
Sanitary or Storm Sewer Cap
+ 7%o State Surcharge
+ l0%o Administrative Fee
Amurnt Due
4s.00
45.00
6.30
9.00
Item Total:$105.30
Payments:
Tlpe of Payment Paid By
CheckNumber Authorization
Receirrcd By Batch Nurnber Number How Received Amount Paid
Check OPEN DOOR COMMUNITY
CHURCH
djb 1223 In Person
Payment Total:
$105.30
$10s.30
t0l7/2005 lofl
t*t&&tl3rai
SI'F[IR'GF'THLi3
225 FIFTH STREET . SPRINGFIELD,OR97477 o PH z(541)7 26-37 53 o FAX: (541)726-3689
DEMOLITION PERMIT APPLICATIONS
Your demolition permit is currentlybeing processed. There mlyle a slight delay' of
,pi" , *"rf.i"g days for small structures] due to the time required to-review the
history of the rtr".i"t" to a"tu.-it e if it needs to be documented before demolition'
This documentation is for archival purposes only and will not affect the granting of
the demolition permit. If the structure is very large or comp-licated the
documentation process may take up to a maximum of 4 worki-ng days'
Documentation wiliconsisi of phofogtuptting the building, taking- measulements and
;;kift ;*led dra*infs. ittu ao"uni"ntation wilt be undertaken by the City at no cost
toyou. Documentutioiiit U.!ng d9n3 on all structures dated prior to 1940 that may
have historic importance to the City's development'
THIS DOCUMENTATION WILL NOT IMPEDE THE DEMOLITION PROCESS'
An age cut-off of 1g4O was chosen because this is the d.ate that the National Parks
Service and The SJiilgn"ia O"uulop*ent Code use to determine potential historic
significance.
If you would prefer to complete this documentation yourself you must prwide the
atit;th tfru?oUo*i"finio'r*rtion: r) black and white photographs of each
.tuuutior,, a floor plan"with measurements, and , 1??t"$rtlSXtbqgntfWpruafl8Sl:,r1 I:,measurements. {ollow rules aclopted by the Oregcn utt'rtv
rhankyou ror your patience. iltlH*l*ltl,il;:"-,';rtru;;i H]1
;*3' ::1-':"t-:g? i'i: iJ: i':l i: ; l:. : :
"'nun-'i'J''ioi tl'e O'ctlrn Uiri;iy il rrrr 'ri' ;it
r grant the city of Springfietd permission to enter *, nrffitq?itttT:
-zc4'+i
d|cumentation prior to-the re[uested demolition of the structure locatecl at:
Address: \\tz z\t)s+
Property Owner Signature:
Date:
txr>!- \-h/
-OS
/v*
Job Numberz(Otet ?po\-- ol3 ?7
NOTICE:
irri Eri mrr stlq mfi ilFJ$31
ttsllifl Iilfl#JPff #inooiiiiiiiiti
Anv tgo DAY PERloD.
W,
225 FIFTH STREET . SPRINGFIELD, OR 97477 o PH:(541)726-3753 o FAX:(s41)726-3689
DEMOLITION PERMIT APPLICATION
Address: \\ rz L\e! 5\
Structure to be Demolished:ho.-9e2 W
Job Number:Co .rrlZO of-ol 3??
The applicant is hereby notified that any redevelopment of the subjegt site must
;fiiy';th uff of tfr"'"pp1i*Uf" laws, codes, ordinances, polices and p]ans.in
effect at the time the rehevelopment proposal is accepted as complete f9r Cltf . .
review. This would i""f"au "Jrr"ction
of substandard conditions assoeiated with
iU" pt".""tdevelopment. Examples 9f qgch corrections may include
modification of inadequate drainage facilities; compliance with building set-
backs from property lines; "orre.ti-ot
ofsubstandard sidewalks and street
il;;";"itr,io"irrairrg'drt"*ry *iqth and pla-cement; and other corrections
which may be ,r"""rrury"to comply with existing development standards.
Furthermore, if an existing use is demolished or otherwise removed prior to.the
a*"fop*""t of the p;6;"d;e, then the system -a""4op*gnt charge credit for
lh; ilfiousf,.rirtii,iir" shall expire !"o V*tt a{er tle $ate of issuance of the
a"*otitio, permit ";;th"r;;orrul ofth" previously existing use. (Springn"ld
Municipal Code 3.+16(r)).
My signature below indicates that I have read and understand the above
.orraiiio* relating to the demolition of the above mentioned structure'
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
in OAR 952-001-OO1O through OAR 952-001-
0090. You may obtain copies of the rules by
calling the center. (Note: the telephone
number for the Oregon Utility Noti{ication
Center is 1 -800-332'2344)'
Za#o ^ ?^ a5I
Date
NOTICE:
THIS PERMIT SHALL EXPIRE T UE WORX
AUTHORIZED UNDER THIS PERMII IS NOT
COMMENCED OR IS ABAI{DOI{ED TOR
ANY IOO DAY PERIOD.
W,
Phone: (503) 986-2200 Amendment to Annual
Professional Corporation
Nonprofrt Corporation
Business Corporation
Cooperative
WsterDistric{
REGETRY NuI'G.*t 05 1 800-1 3
ENnWTYPE Z Douesrc fl ronercru
ln accordance wlth Oregon Revised Statuts 192.41G192.490, the informatlon on this applicatlon is public record'
We nu.rsi ;lo;se thle In:firrmatbn to all partiee upon request and it will ba posted on our website. For ofice use onlY
Please Type or Prlnt Leglbly in Black lnk.
To change the Regdstered Agen! use Ghange of Registered AgenuAddress, Form l3l
1) NmueorENnrr Bethel Assembly of God Springfield
Secretary of State
Corporation Divieion
255 Capitol St. NE, Suite 151
Salem, OR 97310-1327
FilinglnOregon.com
a PE|SCNPTL PLecE oF EustNEss 3) ADDressroRIglAruNGilloncEs
2065 Centennial Blvd.2065 Centennial Blvd.
Snrinsfield- OR 97477 Sorinefield. OR 97477
4) PRESIDENT(NameandAddress)
OFFTERS NAME AilD ADDRESSES
5) SECRETARY(NameandAddress)
Joe Pearson Iessv Stoft
2574 Anovo Ridse Ct ?lSR N 8th
Salem- OR 97304 Snrinsfield-91477
o) ExecmoH
Signature:
Printed Name:
Tite:
Date:
Secretarv
Stott
7) Comcf NAIiIE (ro resolvc qu€dlons rvith thls fillng.)
Nita Sweet
DAynME PHoNE NUMBER (lndude area code.)
541485-9523
FEES
No Processlng Fee
'139(Rev. 1/O4)
:*. +
Phone: (503) 986-2200
Fax: (503) 378-4381 Articles of Amendment-Business/Professional/Nonprofit
Check the appropriate box below:
! ausrruessnRoFEssloNAL coRpoRATloN
(Complete only 1, 2,3,4,6,7)
ZJ rorupnonr coRPoRiATroN
(Compbte only 1. 2, 3, 5, 6, 7)
Recsrny Nuu.r*,051 800-1 3
ln ac-cordance with Oregon Revised StatJtb 192,410-19i.490, the information on thia.application is public record.
Secretary of State
Corporation Division
255 Capitol St. NE, Suite 151
Salen OR 97310-1327
FilinglnOr€qon.csm
We must releaso this information to all oarties uoon r€ouost and it will be on our u/Bbsit6., For.office..use onfu
Please Type or Print Legibly in Black lnk.
1) N*ueonConponmoxPffoRroAiilEinrvrErr: Bethel Asseinbly of God Sprhgfield
2) Srnre rne AnncLE NUMBER(S) AND SET FORTH THE ARTICLE(S) AS IT IS AMENDED TO READ, (Athch a separate sheet if n6ce3sary.)
3) THE AMENDMENT I ,As ADoprED oN: September 19, 2004
(lfrnom ttran one arnerdment $ras adopted, idenfiry the #e of a@ion ofcadr arnendrnent.)
BuSINESS/PRoFESSIoNAL CoRPoRAnoN OilLY
4} Gxeqt n+e APPRoPH*TEST*TEMETIT'
I Shareholder ac'tion was r€quirod to adopt the amendment(s). The
vote wa8 as follo/\i8:
liz Membership approval was not required. The amendment(s) was
- approved by a sufiicient vote of the board of directors or
incorporators.
[-'l Membership approval was required. The membershlp vote was as
- follows:
O.$(*)
€r{#6d
to wtg
Nqmbor ot
r€r$6rr
mtithd to vole
Number of
1&€€didod
to be oa6t
Number ot
rc&sor€t
FOR
Nsbor ol
v&scart
AGAINST
f-l Shareholder adion was not required to adopt the amendrnen(s).
- Tneemendmen{s) lme edo$ed by th€ Soerd of.<rir€ctoIs u/iEiout
shareholder action.
[..| The corporation har not issued any shares of stock. Shareholder
- ac{ion was not required to adopt the amendment(e). The
ameodaentts) waa €d#i}{Dy flieli$orporrrtot8orDy Se Doard
of diroctors.
Clasi or
idriEr of
stEres
Number of
ffisE
outstanding
Numbs cfwtsBfibu
to be 6st
Nunb€r ot
TUtEBtkrdt
FOR
Number of
vdtE Ett
AGAINST
NoNPRoF[ CoRPoRAnoN ONLY
5) C+eex are ftrysspfi**TE grArEnEr+T
Tifle
Secretary
6) ExEcunoN
Signature
7; courrcr NAliE (To rosolve quedlons wlth thls f,llng.)
Nita Sweet
hrhf
Pdnted Name
Jessy Stott
DAYflME PHoNE NUMBER (lnclude area code.)
54148s-9523
ReSrlEdPmearirEF€e $50
I No Fee for Nonprollt Typo change only
I Corflr-ationcopy (Odioml) $5
I Pr*e"lno F.ee are rcnrcfuodable.'
: Ptease mtc drec* payabte to'&rporation Dvision.'
NOTEs
Fees may be paid with VISA or Maslercsrd. The cad numbet
aM spiration dste should be sutrnittod on a spanta shet
fd !ou.paobdlon
rt3{Rev.3AX)
'$ qF
Article 1 Thg nElv nalEe of fie non profit Corrroration is: Open Door Communitv Church A"/G
FEES
Phone:
Fax:
(503)
(503)
986-2200
378-4381 Change of Registered
Gheck the approprlate bor below:
@ curuoe oF AGENT AND ADDRESS
(Comphte only I , 2, 3, 4, 5, 6, 1 'l )
fl cxaruoe oFADDRESs oNLY
(Gomplete only l,7,8,9,10, ll)
REG,,rn Nur'rBER 051 800-1 3
NOTE: Use tris form for Cooperatives or Business Trusts.
ln accordence wlth Oregon Rovls€d Statuto 192.410-152.490, the lnbrmatlon on this appllcation l8 publlc record.
We mud rebase thls inficrmatlon to sll padles upon reguest and lt will be posted on our website. For ofice use only
PlEase Type or Print Legibly in Black lnk Attach Additional Sheet if Necessary.
1) Er{rrYiIAME Bsdrgl Assernbly of God Sprinpfield
Secretary of State
Corporation Divieion
255 Capitol St. NE, Suite 151
Salem, OR 97310-1327
FilinglnOregon.com
C}U$IGE OF REGISIEREO AGENT AIiIO OFFICE
2) Ilr Rrosrmro AcE {r flas BEer Gnruuaro To:
Joe Pearson
3) TfiEt{EUrf,EcrsrERED AoEt{T fitis Cor{ttEt{ftD To :fffis
ApPoiITMENT.
4) AOONCSS OF TIIE NEW REOI8TERED OFFICE (Mu3t bg AN OREGON
s&oelAddres3$$6h hld€ntha+bthe mgfcot€d eg€nts bu8lnessofioe.)
Sorinsfield. OR97477
5) THE SIREET AoonEss oT TNE NEW REGISTERED OFFICE AND THE
BUSIIIIESS ADDRESS oF THE REGISTERED AGENT ARE IOENNCAL.
6) Execrmou
(Must be signed by one corporata ofiicer or direc-tor for a corporation or a
rncrnlG{lfliafiager tora limrit d ltabtfity company.)
CHANGE oF REGTSTERED AGENT'S BUSINESS OFF]CE ONLY
7) t{BfuADDREssoF REGIISTEREDAGENT Ohe businessaddressofthe
regtdered€gent helc*unged to the fonou*q'OREGOt'l Street AddY
_
8) THE STREET ADDRESS oF THE Ngw RecsreneD OFFtcE AND THE
BUSII{E88 AI,T,RESS Of T}IE REG{SIEREO AGEI{T ARE IDETJIICAL,
9) NorFlcATroN
fl ftre corporati,on has been notifed in writing of this change.
1o) Execulon
(Mud b6 slgned by the reglst€red ag6nt or a oorporats offoer or dlrector for a
oorporallon or a rnernber/manager fu a Imted [abi,Uy cornpany.)
Signature:
Printed Name:
Title:trSignature:
frinted'N8me:
6
Jessy Stoft
TftIe Secretary
t't ) COI{TACT t{AliE (Io resolvE quesiohs uffr this fling.)
Nita Sweet
DAyIIIE PttsIE lruMBER Qnclu& area ode.)
s41-485-9523
FEES
No Processlng Fee
131 (Rcv. l/O4)
'& q*
206{ Qentennial Blvd.