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CITY:
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225 NORTI{ FIFTI{ STREET
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PRoCEDURE FoR lNgFECTlct l REaUEST'
REGIgTRATION NO.
GALL 12e.-3169 (RECORDER ) STATE YOIJR Crry DEglcl.lATED JOts NUI.IBER JOE ApDREgg,TypE oFINgPEcrlohl REauEglED AlD IIHEN YotJ tulLL EE READy rcF? INgpEclohl, cohtiRAiioes on otu.rees NA,IE aqDFHCNE NUMAER REAUE9T9 RECEI\.€D EEFORE 1:OQ Nl UILL BE I'1ADE II{E gAfiE DAY, REAJESTS r ;;7ER1Zo@
AI"l UJILL EE MADE THE NEXT III2RKINC DAY
EXtSTrl.lc BLJILDING PEB1IT NO.(tF APPL ICA3.LE )
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*YOIJR CITY IGNATED JO3 No. l5r 120376sEE BOOK
gIDEIIJALK / DRI\GUJAY
FOR ALL CONCRETE PAVING IUITI]IN
THE STREET RIGI]T OF I,UAY, TO BE
I,IADE AFTER AJ-L EXCAYATNG
15 COMPLETE AND FOR!.1 uJOR<AID 9UB-3A9E IIATERIAL 15
IN PLACE
CUB / APPROACI{ AFROhI,
AFTER FOR'.IS ARE ERECTED
BUT PRIOR TO FOURING
CONCRETE.
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CO\.IMERICAL DRIVEIUAYS 9I-]ALL
HA\G 5'TO A'FLAIRS
3'. @'STA"IDARDTOTA FERI-IIT FEE:
I iiA\€ CARERILLY EXA}.1INED TI]E COI-IPLETED APPLICAT ION FOR FEtr1IT, A\D DO i-.IEE3Y CERTIFY THAT ALLINFORTIATIOhI I{EREON 19 TRUE AND CORRECT , A{D I FURTI{ER CERTIFY'I-I]AT ANY AND ALL IIPR< PERFOSIEDSiIALL BE DONE IN ACCORDANCE IUITH TI{E o@ INANCES G TIIE CITY G 9PRIN/.f,IELD, AD THE LAI]JS OF TI-JESTATE OF OREGON PERTAININC TO THE UICR<DESCRIS=D I{ER=IN, A\D Ti.]AT NO OCCUPA\CY UJILL EE I'1AD=G ANY STR.,ICTURE UJITI{o,JT P=R.1Ig3IOII OF TI{E BUILDING DIVISION I FURTHER CERTIFY T|]AT ONLY CONTR.ACTOR9
IUITH ORg 1O1O>> UILL BE U9ED Ot.I THI9 PROJECT.
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