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gPRII.IGFIELD, OREGOhI 914"11
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IN9PECTIO|I LINE:'126 -3163
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ADDRE93: 33,4fti CITY:
9IATE: A@t Zt?, ?747 7 Pr.{or.rE No.74?- 77O I
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IDRK TO EE FEFFOFI'IED EY: outlER
SIDETIJALi<. X CUR9 9IDE
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gECOFID DRI\.€IUAY ( gEE TR,AJ=FIC )
REAUIE9 AFPLlCATlohl FoR A 9EcoND DRhGtuAy(T-4.1a)
OR A COI.hITY AFPLICATION rcR FACILITY FEFIIT (C AA-2O3)
IF IN TH= U6.8.
DATE G APPI-ICATIOI{a-f-77
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R=GlsrRATtor.{ No.x €/ 48
RECETF'T NO: aO+ 112-
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C+.IECKED FOR DEL INAJENCIE9
9IGNED;
DATE:
fiaO 77?<oA
*r A, S///TH EXFIRE9,Z z
ADDRE99 Qzfr ,Pi-iONE:
FROCEDTJ:FE FOR IN9FECTIOI.I RE@IIE9T:
cAlL 12b-3169 (RECORDER ) 9TATE YOIJR Ctry DESIGNATED JOB NLI,I3=B JO3 ADDRESS,TYPE oFlNgPECTla'l RtAJEgfED AND [rrlEN YoU IUILL B= FEADY f-oR lNgP=cTlAn, cO].tTRACIoRg oR ouhlERS NAI-1= l*'lD
FI]OhIE NI.O-I3ER. FEAU=gTg RECEI\€D BErcFE \@@ M I,UILL tsE HADE TI{= 9A1E DAY, REAUE9T9 ETERNOO
AH IUILL BE T1ADE THE NEXT tIigRKII{G DAY
EXI9T II.IG BLJILDING PER.1IT NO. ( IF APPLICABLE )
*YOUR CITY ,rED Jots No. ref 72 a g /bgEE tsOOK
REOTJIRED IN9PECTIOhIS CU@ / APPROACI-{ APROhI,
AFTER FOS15 ARE ERECTED
BUT PRIOR TO FCURNG
C,oNCRETE.
CONCRETE PAVING I,UIT|-.IIN
TI{E STREET RIG}.]T G IUAY, TO 3E
I,1ADE AFIER AL EXCAVATING
19 COI.IPLETE AID FOB1 [JOR<
AID 5U3.BA,9E I1ATERIAL 15
IN PLACE
ToTA PEffllT FEE'I /6, /O
CURB-CUT
O.OO + tO.lb/LF. ( X ) 14' rtO.OO + tO.tb/LF.( X )
OF UJALK flrx , /r_- g,/o
UJALK X,
COi.IMERICAL DRI\EI.UAYg SHALL
HA\G 5' TO A'FLAIRS
3'- O',5TA"'.IDARD
9IDEITALKg
i IA\G CAR=.=JLLY =XS1I}.iED T+JE COI'IFLETED APPLICATION FOR FEffiIT, AlD DO I{EREBY CERTIFY THAT ALL:N, RI1ATIOI.{ H=REON 15 TRLIE A\D CORRECT. A\D I FURTII=R CERTIFY 'ii]AT ANY AND ALL LIi2R< PERFOR.IED5;ALL 5E DON= IN ACCORDANCE tLJlTH TllE ORDIN,{.ICIE9 G Ti{E CITY G SPRlNr.rFtELD, AID Ti-.{E LAuE cF Tt-iEgTATE OF OR=GON FERTAINING TO THE IIJORK DE9CRISED HER=IN, A\D '|'HAT NO OCCUPANCY I].JILL BE I1ADEg?RJC?URE U'ITI-{OJT PERiI59IO,N OF TI-.IE BUILDINC DIVISIO\L I FURTIiER CERTIFY iI]AT ONLY CONTRACTORS
ug=D ON Tl-.ilg PROJECT.IUJO ARE IN COMPLIANCE IIJ|TH ORg IOIO>> IUILL 3E
DA'iE
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