HomeMy WebLinkAboutPermit Sidewalk 2000-07-14I E D E DI I E
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SUBDIVISION:
ZIP: a7
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PHONE: ?'t I -1 t{ I 5
STATE: ()ztP: 1 7<1?.?
OWNER:
SITE INFORMATION:
TAX LOT:
TAX MAP:ADDRESS
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*PERMIT NUMBER:
DATE ISSUED:
225 FIFTHSTREET
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION
oFFtcE TELEPHONE (503) 726-3753
APPLICATION DATE: :P-l
LOCATION OF
APPLICANT
ctw: SCtrL STATE: G
REOUESTED PERMITS
Q PROOF OF INSURANCE: $5OO,OOO MINIMUM tF WORK tS boNE BY PRoPERwoWNER
ADDITIONAL DRIVEWAY:F
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.$ 30.00
TOTAL DUE WITI.! PERMIT S
@$0.06 sF.
...........$ 10.00
$ 60.00
$AMMOUNT OF SIDEWALK IN EXCESS OF 9OFT
fl STDEWALK REPATR:
El DRIVEWAY/CURB-CUT/SIDEWALK: ......
CONTRACTOR INFORMATION :
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PHONE: 7q q-58 3
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CONTRACTOR REGISTRATION NO
G
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PROJECTSUPERVISOB: <,\ruc.v-
CONTRACTORT
ADDRESS:
EXPIRATION DATE
PHONE:
INSPECTIONS:
AN INSFECTION REOUEST SHOULD tsE MADE PBIOR TO POURING CONCRETE, AFTER THE PNOPOSED WOBK HAS tsEEN FORMEDAND MADE READY TO POUR.
cuRB cuT AND SIDEWALK INSPECTIONS CALLT?q-.320e_(EECORDER) STATE YOUR DESIG|NATED CtTy JOB NUMBER/PERM|T
ryVUFE-Rrlo-B ADDIESS-, fYEE oF lNSPEcTloNf,F_o_qEsIEqlAryq WHEN You wlLL eE nEADv ronlruspecior{ LorurnAiibn,sOR OWNER,S NAME AND PHONE NUMBER. REOUESTS RECEIVED BEFORE z:oo A.M. W[L[ ae TuAoE iHe-- - -,
q4ltq DAY, REQUESTS AFTER 7:00 A.M. wlLL BE MADE THE NEXT wonKttlc-oeV.'irubiEtirorus ane r-o BE cALLED tNAFTER EXCAVATIONS ARE MADE AND FORM WORK IS IN PLACE BUT PRIoR To pouniTlc CoNcneie.
rH E LAN-E -ur Ldid$^eb'dffBiflritr ru c co u N"ONE CALL NUMBER' 1-800.3-3I.2944
CIL'S
48 HOURS BEFORE DIGGING
SIGNATURE:
PERMIT AP ICATIONEWALI(
AMOUNT RECEIVED:
RECEIPT NO:
DATE PAID
RECEIVED BY:
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,application and do hereby.certify that all information
be d0ne in accordance with the Ordinances of
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the City and the costs w
proper time, th.at project address is readableunng conslructton.
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