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HomeMy WebLinkAboutPermit Building 1979-10-24uqb (see)POST THIS PERMIT ON MAIN BUILDING AT SITE JOB ADDRESS CONSTRUCTI ON PE RlVllT + TRS. TL: Subdivision:' 11-or-24,+2, /4P This permit for the relerenced property is hereby Setbacks and other conditions of approval must be strictly observed result in rcvocation of this permit, citation under provisions of Lane County's lnfraction Ordinance, and/or other remedies allowed by law. Violation can Applicant/Address: Owner/Address: Contractor/Address: Contractor's OS + Construction a by this permit Total Construction Value: Telephone: Telephone: Telephone: + Bedrooms:Water SuPPIY: PLANNING DIVISION + Plumbin Fixtu res:+ Employees Zoning: Partitioning + Parcel + tVlinimum required structural setbacks, from: centerline of road, front: Parcel Size ; centerline of road, S0 x l"td side exterior: Special lnstru ctions ; interior property lines: ;rear property line: For information call 687-4394, WATER POLLUTION CONTROL DIVISION Site lnspection +* lineal feet of drainfi . lnstallation specifications: eld required; max. depth of trenches Df gal. min. septic tank capacity; Special lnstructions Premt &ra{rrft*Ld fm dmgg &nrf"ug ffirtrEat{oilrr Setbacks I n t-e r i o r p rop e rty I i n es ,Edgc of road right-of-way €uilding founchtion Wells, other water sources Septic Tank Drainf ield10----T0'- 10' 5', 50' 10' 10' 1 00'For information call between 8:00 - 9:00 a.m., CONSTRUCTION PERMITS/INSPECTION Dlvlslohl Type of Construction:0t Group:Fire Zone 3lnstructionsSGc rrtrxr a pLmr rs&etrillsg {sllad *,r*ep*eulmn Use Classif ication:*ec FssS For plans information call For inspections (see back of between 8:00 a.m. and 9:00 a.m., this permit) call 687-4065 between B:00 a.m. and 5:00 p.m. Directions to Site Date lssued: c55-1 3 Yolands; 10*24-?0 Prscqd Bo I"9tS tpf,d" rtre*.sht ih6d to Isl.dnn Lcft By: DEPARTMENT OF ENVIRONMENTAL MANAGEMENT COURTHOUSE / PUBLIC SERVICE BUILDING 125 EAST 8TH AVENUE, EUGENE, OREGON 97401 lane county6l!' - S I TE INSPECTION Appnov r D Reurnr s Dt sappnovro Dare I Hsprcron FOUNDATION I NSPECTION APPRovEo N DrsappRove o f-7 oatr. lG lCo 84 truspecron t// Rruanx s 7? o3S &v< FRAMING INSPECTION Appnov e o Rr uanx s D Drsappnoveo D Dat r I Nspecron LATH OR SHEITROCK INSPECTION Ap pRov r o Rrxanx s Dt sappnoveo Dar r I Nspecton F I i.lAL I NSPTCT l0N Ap pRov e o M Dr srppnoveo Reulnx s o CJ o^,,-lb r{04[1 rrusprcron qil *lt ou t -6v CERTIFICATE OF OCCUPANCY Rerov ro lssue ReuaRx s D Nor Reaov ro lssuE D Dore-I NSPEcTOR -.t l\ Ul-'o 6 _r?. .Yil -.: i'-r /J. t- I I G. .!., ("rlp A 5()- -';\-i{8 A c .--- '.-1 ) I ' , (i-'., ':' PLAtu'l i lJtz AR{t-)--. €c' I l_ Itl' I \) \l l ,}-x\ ,. .?r.;\l ?. --"1* 6 ,o/^/^ I --- SU PPLEMENT f orm /4C74- 185r' TRS, Subd TL a3- 49 Z atu. SUPI-TLMENT N0.ot *O APPLICATION NO. Job Addre ss ,? Not'ify : /l 0wNE /J c0NTRACT0R/Appl icant by: /-/ natl /:/ phone 4-4 res a rCS S pho ne p one BUILDING VALUATION ( Rev'i sed ) ( Prior ) Descr j ption correc ti on add'i ti on Bl dq.was[e -=,-4 Pl umb. 4% sur. Plan R. Mech. 0ther ,fr amt. due refund ___77_2_ d1-5 . _ ,tr TOTAL: rA id Appl icant' s Sj gnature &-x Cash Check # Received bY //l/.PC due By Da te /-/ cPer By Date INV I RONMTNTAL MANAGEHENT DEPARTI4ENT ArHtNlsiRAltvt Dt\/lstoN I 125 IAST 8TH AVEHUT / EUGENE, OREGOiI 97401 / (503)687-4394 0R I-B00-452-6379 g +h Permlt I Permlt Permlt For TRS, TL Subdivision Lor g Plcrt PIan Job Locatlon (Addre Pernlt f PemLt Permlt ForFor ForFor Block I 4 X adNaTcl o Lnru D4 Jp\ e,e /9 zo il ;81 {oJ d o- on oVnhii) g-= -.\9il &'ts ;P ,-so.) DiG' rD e- 5-o <D zeO, :r ?JD;, d f;, z S rIr\ \R4 I l" r -']8, ts lr" S - t*u k o oY / // N \ e t B fi $' o 70 )t1e i3,6rY \ *1 { q flgs ;bo13 a ?b 3i rnP D N I IoCy) ,-n B Z rr\ EPo e_I c, t,o 2,+-v 5-+v o I 5 E -rt R s -{ o LTVlctnlty llap ff ( / -x Io o tr v {: te_,\ I II 1 ')fi,L:; ,9, '- - )r &', \J uvw 4cJ: Jr\v1d l -\)a- -'.. -)/1 --- ' J,-) - -.'/rt \\ L-- -- o)h. L t\ aot^ J.\ d )1 I i '€.() e o" ,.;, \-<>5 1u,y \d ) r'.t ^Yov \/& {: I I : 7oa q ,rLt1 -tr) ..1 . __-- ---' ( I YA POST THIS PERMIT ON MAIN BUILDING AT SITE JOB AEDRESS:2755 [orth 20th Spf,d' Ore CONSTRUCTTON pERMtT # Le3U5-79 TRS, TL: U-03-24 f 4300 Subdivision: ha edd to Phfl.yss P.rk, Lot 2 Blocl 14 This permit for the referenced property is hereby .pprqv.d. Setbacks and other conditions of approval must be strictly observed. Violation can result in revocation of this petmit, citation under provisions of Lane County's lnfraction Ordinance, and/or other remedie6 a owed by law. Applicant/Address: Owner/Address: Contractor/Address: Contractor's OS + Lawrence K. Bright, 3834 Main Spfd, ore Lenny Martln, 2756 N. 20th Spfd Caskade Poole, 3834 maln Spfd 2L479 Total Construction Value: I Construction approved by this permit: pool Water Supply na Telephone Telephone Telephone 747-7245*t t t I 747-7245 Structures notr on property! house and SDS +t Bedrooms: na + Plumbing Fixtures: na * Empl oyees: na PLANNING DIVISION Zoning: Agt (RA) Partitioning + na parcel + Minimum required structural setbacks, from: centerline of road, front: side exterior: na ; interior property lines: 5t ;rear property line: Special lnstructions:na rra 451 5r For information call 687-4394,Donnalee Meigs WATER POLLUTION CONTROL DIVISION Site lnspection + ns lnstallation specif ications: na 'a lineal feet of drainfield required; max. depth of trenches: na gal. min. septic tank capacity; Special lnstructions: Protect dralnfleld from damage during construction. Setbacks fiterior property lines lge of road right-of-way ouilding foundation Wells, other water sources Septic Tank_--1o'- 10' s', Drainfield -T0-- 10' 10' 100' AnY alteration ol tha natural conditions in lhe area aPProved lorthe drain- field or replacement area will 50 For information call 6g7-395gbetween 8:00 - 9:00 a.m., John void this approval.Crulckshinkrrs CONSTRUCTION PERMITS/INSPECTION DIVISION Type of Construction: na Group: M Fire Zone: 3 Use Classif ication:Res Pool lnstructions:See notes on plans regarding calIed inspectlons. For plans information call 687-3767 between 8:00 a.m. and 9:00 a.m., Jln Laub For inspections (see back of this permit) call 687-4065 between 8:00 a.m. and 5:00 p.m. DirectionstoSite: Proceed ton 19th spfd, straight ahead to Yolanda, left turrr on n 20th, accross froi Date lssued: Iolanda, house is on left side of 20th Bv:Lo-zh-ts SEIXTIIB',tI?F,fJLYfSH,=,|'JI'TMANAGEMENT rss/lt<vC5$13 125 EAST 8TH AVENUE, EUGENE, OREGON 97401 Parcel Size: 80 x 156 ; centerline of road, county \ LI ) DEPARTIlENT OF ENVIRONI4ENTAL I'IANAGEMENT PSB, I25 EAST BTH AVENUE EUGENE, OREGON 9740I rh Addre s s Appl ication for Structures now on the Property Affidavit: I If this appli cation is for an agr cu ra ilding it wi Lane County Code Chapter 10 (zoning) and for no other purpose. I .#-* :911;5:p; L-l ittffiii$i*#f$3ili /-/ if..$-$.*',r,#l,l hereby certify that this information is true and accurate d for purposes allowed by the State Building Code and have the following legal interest in the propertyr Xi *'uuii..,l*lii /:/ I be use phonen trac owner of record;ontract purchaser;I essee;holder of an exclusive option to purchase; ,< ou Si gnature/ Tel ephone l.lhen permi is ready noti : /-/ Applica1l Owner Con trac tor Contractor's 0SR# If Commercial Residential: SI test holes ready ly authori Add res s or the own eo f-TEls app i cati or Date /-/ na.Owner !x Plumbing by # of employees z1 /_/ Ex isti ng, BP # l/ Proposed, SI # Phone Va l uati on \-ad- .,:h,Se.i. $qf*iffisEr:tjp#*flrii: ,sg|triit+,i.i.iUn.,. ffi*$i..t,.i{fiit,ltsg.,. .$q$$,,Fee $ Total Va,l uat'ion .,tl;ffi t'ogi;$f $u$*g.. ii$.,f *:rl.Brifi ElIi:':,ugtl#lili: each $- each $ at at $ $ $t_/ /_/ Received by Su btota l $ $ $ 4% State surcharge Pians check fee Change of Occupancy Water Supply Proposed _ Year Instal led Existing _ TOTAL PERMIT PROCESSING rt. # Minimum setbacks fron t t, side 'i nt.rea r Conrnents q_ To be typed on permit cP&l lype **Grou p To be typed on permit By Fire Zone Use Classification By Da te Ph teZ Date to PCC For p'lans information ll (area i spec tor ) Di rec ions to si Pl ans to CP&I _ set(s ) I,JPC _ set(s) tt-al Or\/_/ sI Requ i red PCC /_ / Pl ann ing /-/ Public Works , Elevation /-/ n/a /l Address /_/ Fac;1 i ty Permi t / / Environmental Health FoR INF0RIIATI0N about progress of your application call c74-L7l I eted CP c Aga Da te permit control center 687_HELP (687-4357) I $ Parcel #_ I 2.! 3 I 5 6 1E,. IO 12 14. ll ?0 72 21 26 2a l0fl 32 t6 -34 i-ril.il. []lllii,il't ii[::i:]'i' - it f' l'' l.- .L L-. f..i i\ i L r:i ,:. ii ir.i lj f:. r' iJ l..i l.- ,}. 1,t llli LJI(.1 i "'r tJt l i'fi i:'T I I i{ 'i 'r u ..\ Iall! i ili!:11.1 !'r:!: i,: !I!- 1 I .l r,r. i ij r.il I :t.i I I I la? l,:la I .i NHt'i $t-$G I'YF'[. Liii[:: fi N{:i FI}RHtr ':}Sjq -' u*f tr: dll.'f.'i- tltj f\l-:1' j:tjN tlHS:r-;ft I Fj'i'I if N FI'' l"ii:!J l-'titii-.40 tr-{ F, '-*F -42 L.:: l\lt I LtJl\ltr.L. I t-ll"jJ : l.1F:fl{fti'i I tAL frt:E: d I 11 I !.- L(r-.il\Ultrll1.*!- r1..{-{H L.!'1L.L,ii. r L.r. t:.L..L U Fi.Lr.i,rf! {:iiHFL.i;:'ifi:fi }iY I 52 r1 -i* -./. t't!T'At_. r'EIs.E ti I.I /'r_--l.iUo t2;!.1 ll a t02 tgti8l ; 6; s.*. E l' 56 l'f\l:Ht.l fJY i-:l:. I I3t_H 58 I 60 62 bl LJi:'f F i.-FrN t- r' - rP RTI1INT OF ENV I RONI4Ei.]TAL I1ANAGEI'lENT PSB, 125 EAST BTH AVENUE EUGEl'iE, OREGON 9740I t # Assigned Numbers rh Job Address Subdivision Appl ication for Structures now on the property Proposed use of property:/_/Residential /_7 Commercial Affidavi t: I , ease cu l tural bu ld ing it otherzoning) and for no contract purchaser; t .J7,. Bl ock f7Industrial //Public hereby certify that this information is true and accurate. b ty If this application is for an Lane County Code ChaPter l0 ( be used for purposes allowed by the State Building Code and purpose. I have the following legal interest in the property: lessee; holder of an exclusive option to purchase; Con trac tor t the owne Tel ephone is ready notify: /7 Applican,t / 0wner e of-This applicati ? 0r Da te !x / mailWhen permit Owner Contractor's 0SR# If Corrnercial: # of stories Residential: # of bedrooms SI test holes ready Descri pti on z1 P1 umbing by # of employees # of units SDS: /:/ Sq. Ft. or # of Sites Existing, BP # 17 Proposed, SI # Unit Cost Phone Valuation {(L I Fee Fee Code I $ Total Valuation: $ Plumbing fixtures at $ Sewer/water conn. at $ 4% State surcharge Plans check fee Change of Occupancy eac h s /_/ Casn /_/Check # Recei ved each $ Subtota l $ $ $Water Supply Proposed _ Year lnstal I ed Existing _ TOTAL PERI'IIT PROCESSING Minimum setbacks rt. #Parcel #It, front , s ide i nt.rear Comments To be typed on permit I"IATER POLLUTION CONTROL Instal lation specifications : By Da te - l. tank;f t-.of eld;depth of To be on permi el ephone By Directions to site /-/ srF0 Pl ans to /-/ CP&l /-l -y{t'c /7 Planning /_/ PuOlic i.lorks / / Elevation /-/ n/a /7 Address 1-/ Faci l ity Permit /l Environmental Health set SE L Requi red te Da te Courp'l eted Date to PCC CP&I I^JPC p S PCC /of Lq-r--r FOR INFORlliqTI0N about progress of your appl ication call Permit Control Center 687-HELP (687-4357) Townshi p, Range, Secti on , Tax Lot S i gn a tu relAdd res s Contractor (ziP) t -\l ( $ s $ ( ,t tn n. -.1) /#//tff Aa.-*l,a*--{U | 6 | i t- . u^- a s 'Y1r PLAtu'r I ile, ARil) ,;) /.s. ! I -/rt - ,.','''Ii I ____ ( J uqP A ao- /S l - "-'1 '. ' (-\....- \_/ a'. .j-.\ I I \t.\I .i! \ bl - -!i l/.li ^7r ,:.1 ) ? 'o Gn ..-'1., t: .., \^ '.-\,<r l) '-s .,,,.r" I , POST THIS PERMIT ON MAIN BUILDING AT SITE JO.9>d'R ESS:2756 Iorth 2oth Spfd, orG CONSTRUCTTON pERMtT* LC-3I95-79 TBS, TL: 1J-€i}.4{.'#4iloe 17-03-?*..1,2 n ? 4u*1u66n: 2oat sdd ro phrryas parL, Lor 2 arock 14 This F'ermit lor the relerenced property is hereby aPPlovad. setbacks and other conditions of approval must be stricdy observed. violation canresult in revocation of this permit, citation under provisions ot Lane county's lnfraction ordinance, and/oi other remedies allowed by law. Applicant/Address: Owner/Address: Contractor/Address Contractor's OS + Constructio n approved by this permit ) Water Supply Lanrence K. Brlght, 3834 Maln Spfd, Ore Lenny l,larria, 2755 N. 20th Spfd Caskade Poola, 3834 uatn Spfd2L479 Total Construction Value: I Telephone Telephone Telephone 747-7245*).r.* I 747-724s Pool Structures now oo property: house and SDS na n Bedrooms: na + Plumbing Fixtures: na na+r Employees: PLANNING DIVISION Zoning:Ast (RA)Partitioning * na Parcel +r na Minimum required structural setbacks, from: centerline of road, front: h5r side exteri Or: na ; interior property lines: 5t ;rear property line: 5r Special lnstructions 114 Parcel Size: ; centerline of road, 80 r 156 WATER POLLUTION CONTROL DIVISION For information call 687-4394 , Donnalee Me Site lnspection +r n6 lnstallation specif ications: nana lineal feet of drainfield required; max. depth of trenches: na Septic Tank 10' 10' 5', 50' gal. min. septic tank capacity; Special lnstructiorrs: protect drainfleld frou damage during conatruction. ''l ter Jge Setbacks ror of property lines road right-of-way Drainf ield--T0-- 10' 10' 100' Any alterat'on ol lha natural conditions in the area agproved lorlhe dr:;n- field or repla€ment area willBuilding foundation Wells, other water sources For information call 6g7-395g between 8:00 - g:00 a.m void this acoroval.John Cruickehirnhrre CONSTRUCTION PE RMITS/INSPECTION DIVISION Type of Const lnstructions: ruction: na Group: lt Fire Zone: 3See ootes on plane regardiug called lnapectloos.Use Classification Res Pool For plans information ca U 687-3767 between 8:00 a.m. and g:00 a.m., Jtrn Lanb For inspections (see back of this permit) call 687-4065 between B:00 a.m. and 5:00 p.m. Directions to Site Date lssued: : Proceed toa 19th cpfd, etralght ahead to Yolauda, left turn on n 20th, accroes frod Yolanda, bouse la on left elde of 20th Bv.Lo-24-7s 33'..ffiil17F,fJil$H,?SJttMANAGEME* -' Jssllky l'E F qT NTH AVFNIItr FIIGFNF TTPFGON O74O1 c(E- I ? COLInrty \ ort lane countyHOtI} SLIP APPLICATION # Name Address p The Lane County Water Pollution Control Division cannot proceed with processing your application because: l. Incomplete appf ication ('items deficient). Address and/or directions to application site. Proposed Number of bedrooms in dwel'ling. Approvable plot plan (see attachment). Notification of date test holes will be ready. Verificat'ion of existing system required (memorandum explaining this procedure attached). Two test holes (2'X4'X5'deep) requ'ired for expansion or repair of existing sewage disposal systenr in the area of the proposed drainfields. 0the r : 2 3 4 { M74 - 181 WATER POLLUTION CONTROL DIVISION / ENVIRONI,4ENTAL I4ANAGEMENT DEPARTMENT125 EAST 8th AVENUE / PUBLIC SERVTCE BUTLDING 7 ' iuerr,rE,-OnEeOn-g7aor"'' 6Bi-406r lane county HOE,D SE,TP APPLICATION # LOCATION NAME ADDRESS The Lane County Water Pollution Control Division cannot proceed with processing your appl ication because: l.Incomplete application (items deficient). l_l naOress and/or directions to application site. E-l Proposed number of bedrooms in dwelling. f]ARprovable plot plan (see attachment): f--] Nottfication of date test holes will be ready. Verification of exjsting system required (memorandum explaining this procedure attached). Two test holes (2'X4'X5' deep) required for expansion or repair of existing sewage disposal system in the area of the proposed drainfields. Other: 2 3 4 S IGNATURE DATE OFFICE HOURS PHONE if the necessary corrections are not made w'ithin days, the application will be denied. l.lATER P0LLUTi0N C0NTB0L DIVTSToN /.I25 EAST 8th AVENUE I PUBLIC SERVICE BUILDING ENVIRONMENTAL MANAGEMENT DEP/ EUGENE, oREGoN 97401 6Bir[M, ZiP UUUt +!t?- o 3 - zl 4s&Job Locatloa (Add Pennlt # 3l9S-19 For fr l crt lan Permlt /l For Permit For Subdivision N Lot 2 Block I 4 14NRKET YO LA NDA T6TA L +h Permit Permlt llE qlo l* duw'ud/ TRS, TL #For For For NJ >r\n 6- * J +.s z No -st.q (/^)zo+y No zlol:l + f.) \rl Dnairurieuo Lervgfh = 15?/ LENGTH OF L'NES ARE: lot €0t 65'. l7'. e l'.r5' /56'ToTnL DATEx I u, I\o e Proposed ,.J oNl I ADOIT'I -lo {\+t t2 \\ ,or* +.$oto 1 - 6r' r Yru%I I IIW \r1 o o 7.7,'.'u 5wr -- =.o -o C,tn rrt c74- 150 Vlctnlty N BY VE Pennl-t tl- r ) ,tu€ PPL Bt k. SUPPLEMENT NO. rorm /fC74-185 or7TRS, Subd TL a3-e Job Address Noti fy: *O APPLICATION NO.7g /6-4t_ t_t C0NTRACTOR/Appl i cant by: /-/ nail /j/phone DslqipU_q! BUILDING VALUATION(Revised) (Prior) re p one p onerCS S ,t correction addi ti on Bl dq. Waste o---O Pl umb. 4%'sur. Plan R. Mech. 0ther ,4 amt. due refund ---a---*415 t ,x Rece /-/ l'i.PC Cash Check # ived by TOTAL: 4{9 paid Appl icant's Sig nature due a- t By te / / cP&r B Date ENViRONMENTAL MANAGEMENT DEPARTMENT ADMII,IISTRATIVE DIVISION / 125 EAST 8TH AVENUE / EUGENE, OREGON 9740I / (503)687-4394 OR 'I-800-452-5379 > br\ N Job Location (mile post v ICINITY MAP Subdivision x FOR SANITARIAN'S USE ONLY COMMENTS: Block System Approved fl System Disapproved tl Needs Correction PtAN o -5 t'tE I s5'!- 1+ 1- ureYotouonFOR INSTALLER'S USE: Trench DePth Filler Depth Below Tile Tank Capacity lrP Manufacturer lVleasured distance to well fro m tank Pab/ti Wn*'e from drainf ieo Rtbnc wt%<a^ or0 lo\ $ -'l Fre*oo \,. NEw oo 0)L!! o) E'(o G) E (UZ J' Pc(o .9 o- o- luJIFt< F f-. N o { Ttl \ JL o, COP c 2- -.t-d'/k -..l <b' uJ(I lF z(, @ Scale: l'3 I -LrttE ksgfu NW q}- % waIs I s \ m +L m o DT !NSTALLATION RECORD AND CERTIFICATE OF SATISFACTORY COMPLETION When signed by the County Sanitarian, this certificate is evidence as per ORS 454.665 of sat- isfactory completion of a subsurface sewage disposal system at the above location. Return this form to: Permit Processing Section, Department of Environmental Management, Public Service Building, 125 East 8th Avenue, Eugene 974O1 c55-1 1 rRs,rL l7- 03- 2+*4,7@ r* / h \ \ .\ \'r, oa k h TRS, TL Job Location (mile post) Subdivision tot 2 Block _tLYICINITY MAP FOR SANITARIAN'S USE ON LY CoMMENTS: cOn 2e/ te1-' a ruJwt"y\Q.LL, Si re FOR INSTALLER'S USE: Trench Depth Filler Depth Below Tile Tank Capacity /ron Manufacturer lVleasured distance to well from tank NOluE from drainf ield PLOT PLAN -1 [] Svstem Aor secfu,^ frU p flor plo n {caro 7? +.s h YAuoNOn t'2 Date ,/1rOiJ€ +I I c m + \ s lo I r'o 55L -Tlz' NEt'r dtrlr:! +, I.lJFt ,o rz'- L,ruE lenoi*As -" ec 11 \later ' +L co oo o)L ! g) E '(o 0) E Z -a c(o(J o-o oi A ) !.,t Iul lslrl<z (9 6 \ wo't$J 70 Sca le t t8E-t,t 17 TTTAL INSTALLATION RECORD AND CERTIFICATE OF SATISFACTORY COMPLETION When signed by the County Sanitarian, this certificate is evidence as per ORS 454.665 of sat- isfactory completion of a subsurface sewage disposal system at the above location. Return this form to: Permit Processing Section, Department of Environmental [Vlanagement, Public Service Building, 125 East 8th Avenue, Eugene 91401 0) GP c C.(A \ N c55-1 1 : \ st \ 0 \ o \ \t / { 6.c-i -CTf{ a_ T\l C \s1s TRS, TL Subd. PPL SUP LEMENT NO. LOt- BIK.- APPLICATION NO. Forn !1C74-LB5 Job Address Noti fy: /7 owrurn address 7- 7 COrurnnCT0R/Appt i cant phone addressby: /-/ mail fl phone phone /-/ ant. due/ / refund . BUILDING VALUATION(Revised) --'['p.iorl correction add i ti on Bl d9. Was te Pl umb. 4%'sur. Plan R. Mech. 0ther /-/r/ D/_/ Rece Cash Check #TOTAL:pa id App'l icant,s Si gnature due ived by /-/ wpc /-/ cP&r By Date 3\A(/\ 1l\)\ Date ADMINISTRATIVEDIVISION /, ENVIRONMENTAL MANAGEIT4ENT DEPARTMEI,I}125 EAST BTH AVENUE u - ruCerur','-ijnr[6i,r^iil'bT' z (s03)687-4394 0R I _BO0_4 s2_637s Descri ption