HomeMy WebLinkAboutApplication APPLICANT 12/8/2021City of Springfield
Development & Public Works
225 Fifth Street
Springfield, OR 97477
PERMIT REVIEW INTAKE FORM
SPNINOF'I�
(City Staff completes form)
Permit Type
Dept of Motor Vehicles -New: ❑ Land Use Compatibility Statement:
City:
Dept of Motor Vehicles -Renewal: ❑ Zoning Verification Letter: ❑ UGB: ❑
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Applicant: Phone: SQ
Company: G .n ��
Email:
Address: ttz'� S�
Property Owner:
Company: Wy
i Mf- LLL
Cell:
Address: mk-1
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ASSESSOR'S MAP NO: ` ,n--1t_L1b
TAX LOT NO(S): D3Vo
Property Address: kLk-I XAV -,,,
Description of Proposal:
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Record Information
Record No: pi�_Z.�._UU031L1
Date Received: L
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Application Fee: $ 3LL` .o O
Technical Fee: $
TOTAL FEES: $ 31' . Lib
Assigned Planner:
Revised 11.2.11 Id
(City of Springfield
Development Services Department
225 Fifth Street
Springfield, OR 97477
Minimum Development Standards
Land Use Compatibility Inspection
SPRINGFIELD
Property
Address/Map and Tax Lot
2147 Main Street // 17-03-36-42-03400
Zoning
Community Commercial
Building Size
(square footage)
COMPLIES
Existing Use
Vacant (previous coffee kiosk)
Proposed Use
Food Truck connect to sewer in previous kiosk location
Site Visit Conducted Date
OCCUPANCY
Final Site Visit Conducted
MET(DATE)
LUCI Issuance Date
Planner Assigned
Contact
Street Trees
❑
❑
Associated Permits
Minimum Development
REQUIRED SITE
COMPLIES
CONDITION OF
NOTES
CONDITIONS
IMPROVEMENTS
OCCUPANCY
MET(DATE)
Street Trees
❑
❑
2 tree(s) req.
Stormwater Catch Basins
❑
❑
1 filter(s) req.
Bicycle Parking
❑
❑
4 space(s) req.
Parking Lot Striping
❑
❑
Restripe existing parking
areas.
Screen ❑ Cover
Screened Trash Receptacle
❑
❑
❑ Pave ❑Isolate
❑ Drain
Maintenance of Existing
E]❑
Site Improvements
Revised 3/17/11 ddk 1 of 2
By Signature, I state I have carefully examined this change of use approval and do hereby agree to
comply with the requirements of the approval and certify any and all work performed shall be done in
accordance with the Ordinances of the City of Springfield, applicable City Standard Specification and
Drawings and the laws of the State of Oregon pertaining to the work described herein.
The City may inspect the work site described in this approval at any time during a one-year period
following the receipt by the City of notice of completion of the described work and specify, at the City's
sole discretion, any additional work required to bring the site into compliance with all applicable City
standards. In the event conditions are not met prior to occupancy of the building or within thirty days
of issuance of the approval, Code Enforcement will be notified of an infraction and a citation may be
issued.
Name (Please Print)
Signature:
Date:
Revised 3/17/11 ddk 2 of 2