HomeMy WebLinkAboutPermit Building 1987-04-02D
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Lane County Authori za,ttott for'
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FOR OFFICE USE ONLY
",//a3-f7Applicatio
Permit #
P
1 RANGE SECTION
LOT,/PARCEL BI.oCK
PROPOSED USE OF PROPERTY
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# OF EI'IPLOYEES WA PPLY P ,posed
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TELEPHONE NUMBEROiINER'S !$AME AND AD.DRESS r I
l,-to-r irn 0IutS
S NAME osR
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TELEPHONE NTJMBER4K5-ry'fl
TELEPHONE NWBER
I HAVE CAREFULLY EXAIIINED IHE COI.IPLE?ED APPLICATION FOR PERMTT, arrd do hereby cetti,fy that aM.nforration hereon is true and correct, and that I
have the following f,egal interest in the property, Io*n". of record; f] contraut. prrrchaseri f authorizetl agent.
I f:rther certify that any and aII uork perfomed sha1l be done in accordanr:e with the Orditrances of Lane Comty and the Iaws of the State of Oregon
pertaining to the work described herein, and that No oCcUpANcY will be made of arrl strrrcture without the pemission of the Builaling Division. f fur-
ther certify that registration with the Builder's Board is in full force and effect as required by oRs 701.055, that if exempt the basis for exempti
is noted hereon, and that only subcontractors ad employees who are in conpliance with oRs 701.055 will be used on thj,s project. I HAVE READ AND
CHECKED THIS APPLICATION THOROUGHLY.
NaME (please Print)SIGNATUR.E DATE
Date:
rnstallation Record rssued? [l v.= [ *"P.
/Installation
Speci fications
COMI1ENTS r
Date:
COM}IENTS:
Date
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ItAS
fPLANNING,/ZONINGtr
of ainfie ld
READ THIS SECTION
l'linimum Setbacks
SANITATION: s, I. *
Parcel #
BEEN BASED ON THE POLLOWING CONDITIONS:
cor4}lENTS
rear
Parcel
Tank
llon LineaL Feet !,laximun Depth
of Trenches
BY BUILDING OFFICIAL/DESIGNEE
E COUNTY DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION,
oRs 456.805 1
125 EASTSTH AVENUE, EUGENE, OBEGON 97401
SEE REVERSE FOR INSPECTION INT'ORMATION
Fe* u^q 6E
DATE
687-4061,
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Eugene, Oregon 97401
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