HomeMy WebLinkAboutApplication APPLICANT 7/14/2008
,
City of Springfield
Development Services Department
225 Fifth Street
Springfield, OR 97477
JUt I 4 2008
Date Received
Ongmal Submittal
TEMPORARY USE - Emergency Medical Hardship, Type II
. -.
Applicant Name: A / ptVr7~ (" wllllK'1"/7 (a-s e-
Address: I /i/ 30 J ,')'ft. ~51r~
Property Owner: I AIfM1/'lA 5vVan~F77 ~{-L- Phone: I 7f/7 7'1~J
Address: I Ic;f (l 5.f/r ,5f: Fax: I
ASSESSOR'S MAP NO: IT 032& 3 [0 ,TAX LOT NOeS): /000
Property Address: Ilf ~O ':5+11- ~e.e;t-
IType of Living Unit Proposed: I D Residential Trailer I ~;avel Trailer I D RV
Specific Description of Proposal: ID f fa: {A. +rq-; kr-- e !v07Y1.e- ,5; Ie
J'v J4I ~ fha; ~L-- ({ Cftf ep r CJ v't de.r 1'0 f J'Vl./
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.f-;> -h~ ~ ~jf ,-Itj ( 2-~f;rn '7 I e.--fc -, . <
U Date Received:
JUL 1 4 2008
Onglnal submittal
The undersigned acknowledges that the ,Information ~ t~ a~y~n is current and accurate
Applicant Signatur~:~~~-___ - IDate: 7//f/ar
If the applicant IS other tha~~wner hereby gr er Isslon for the applicant to act In his/her behalf
Owner Signature: _ ~ ~ /...-- I Date: ~'/-f /tJe
Date: 11flf 108 RevIewed by: /-D
Technical'Fee:'$ I~.<g{) Postage Fee:$ ~f.f;D--
I PROJECT NUMBER:
ICm.:-tw1? _ fYjOy-(;;
IAPPhc;tion Fee:$ ?;tlo-
ITOTAL FEE'S t1~. 9D
I
5-8-2007 BJanes
IIn aoortJolr aoaress nas cnangea cro~~ QUI me QIU l:I.uurt:l::.~ II u 1~IQa;:"';: IIILCIC::tL III \lIe YCII.l,.IIC, ","U111t-'ICL'I; I
and write w address and county of residence on the front of t~aSSlgnment on back of the title
the tItle IItie and !he fee to DMV '905 Lana Ave NE Salem OR 97314
SECURITY I "REST HQLDERlLESSOR ~ - _ _-
SIGNATURE AND COUNTERSIGNATURE OF SECURITY INTEREST HOLDER OR LESSOR RELEASING ALL INTEAEST
DATE
I
X
~NATURE AND COUNTERS'GNATURE: SECUR'TY 'NTEREST HOLDER OR LESS.OB RELEAS'NG ALL'NTEREST
DATE
.
~
if A L2924P2449310
02 S7 M6 P5 EO MO 20
OREGON
TRAVEL TRAILER REGISTRATION
PLATE NUMBER IT1TlE NUMBER I PAOCESS DATE /EXPIRATlON DATE I FUEL TYPE
R993524 0720518525 072407 JUL 11, 09
YEAR I MAKE I STYLE tMODEL I VEHICLE IDENTIFICATION NUMBER
1993 RSRT RT lEA1L2924P2449310
TITLE GRANOS l'f Ii C \ODOMETER READING
ODOMETER MESSAGE
EQUIPMENT NO
WEIGHT/LENGTH
29
OWNER!
LESSEE
IODOMETER DATE
GABEL, DEANA LYNNIE
GABEL, DEAN JOSEPH
91406 PLACE LN
JUNCTION CITY OR 97448
COUNTY OF
RESIDENCE
LANE
COUNrr' OF
USE
NEW
ADDRESS
OREGON AUTO INSURANCe. IDENTIFICATION CARD
GuldeOne Hutua/Insurance Company
1111 AshYlOorth Road. West Des Moln..s lA 502653538
1(515)2675000
Date Received
~LICY NUMBER
I 071052433
I YEAR
1993
I
VEHICLE IDENTIFICATION
lEAlL2924P2449)10
INSURED
Dean Gabel
Deana Gabel
91406 Place Ln
JunctIOn City OR 97448
EFFECTIVE DATE EXPIRATION DATE
08/14/2007 TO 09/13/2007
MAKE I MODEL
RSRT RT 29
COVERAGES
JUL 1 4 2008
,
Onglnal SubmlttaL~
YOUR AGENT IS
Rod Schultz Agency Ine
AGENT PHONE NUMBER
5413436582
seE REVERSE Sloe FOR IMPORTANT INFORMATION
DATE CERTIfICATE ISSUED 08/14/2007
225 FIfth Street
Sprmgfield, Oregon 97477
541-726-3759 Phone
,
Job/Journal Number
DRC2008-00046
DRC2008-00046
DRC2008-00046
I'ayments
Type of Payment
Check
{,\{elemll
RECEIPT #:
~~
AD' of Sprmgfield OfficIal Recelpl
"'Wvelopment ServIces Department
Pubhc Works Department
2200800000000001077
Date. 07/14/2008
DescriptIOn
CTY TU - Emerg Med Hardship
Postage ree Type II - $160
+ 5% Technology Fee
PaId By
ALA YNA CASE
Item Total
Check Number AuthOrizatIOn
Received By Batch Number Number How Received
LD 1818 In Person
Payment Total
Dwte Reeeived:
JUl 1 4 2008
Onglnal Submittal
Page 1 of 1
2 34 59PM
Amount Due
276 00
16000
13 80
$449 80
Amount Paid
$449 80
$449 80
7/14/2008
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Date Received-
JUL 1 4 2008
Onglnal Submittal
/1.; 3D S1itSfrEet.
SPRI!JyA6L-D
RfJ('UC(!7 :200 I?
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CITY OF SPNl~61'1J!,i..D
VICINITY MAP
DRC2008-00046
1430 Fifth Street
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SITE
~ Map 17-03-26-10 -
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Tax Lot 1600
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Date Received:
JUL 1 4 2008
Original submittal
TELEPHONE/INCIDENTAL
~UNTER
* BARGER
PATIENT
ADDRESS
SWANSONCASE, Alayna M
1430 5TH ST
SPRINGFIELD OR 97477
CONTACT RE letter
To Whom It may concern,
Provlder
Med Rec #
Date
9Aug07
~
26418
01046971
9Aug07
DOB
llMay1976
Alayna Swansoncase lS dlsabled due to lmmuno-suppresslon
Slnce her llver transplant at age 8
progyeSSlve organ
MD slgnature
Mlchael Laurle MD
4010 Aerlal Way
Eugene, Or 97402
dm
Thls lS the end
"""oj
dete~/
26418
She has chronlc fatlgue
9Aug07
VlSlt Complete Y
Date Received:
JUL 1 4 2008
Original Submittal