HomeMy WebLinkAboutPermit Building 1978-6-30
I>~ f'.
J DEPARHIENT OF ErlVIRO~11ElnAL r1ANAGEI
~ . J PSB, 125 EAST 8TH AVErIUE
EUGENE, OREGON 97401
Jo tress' Y/..../'7 I/"""'A";/./) P:!/ Clty LUALu
Townsh,p. Rang~. SeCtlO~. Tax1L;;r7/Z-A~'~;"';""'- d ?5'h7-;?>>- --
,fA (/ ,- -on-~
SubdlV1S10n #?~/~ _
Appl1catlOn fOr Y:____/~Jt? J./ ~
Structures now o~ {t;;'""pr;p;;-t-y--- '1 ~ r .r'"''''
/ -
Proposed use of property I_I ReSldentlal
-
~-"
(
AppllcatlOn i/
CC - cf,'73 -7,~ ~
Asslgned Numbers
"
Lot
Block
() Commerclal
c/ Industnal
() PubllC
Affldavlt I. J/ J //)/JA / ~~ V , hereby cert,fy that thlS lnformatlOn 1S true and accurate
,- yt 151 e"aseFpflnt) - .
If thlS appllcatlOn 1S for an agncultural bUl1dwg It ~1111 be used for purposes allowed by the State BUlldlng Code and
lane County Code Chapter 10 (zon1ng) and for no other purpose I have the followlng legal lnterest 10 the property
owner of record, contract purchaser. lessee, holder of an exclus1ve optlon to purchase.
duly author1ze~to~act for the own~~7who 1S knowledgeable~o~thls appllcat10n
Slgnature/Address ~,~/j;/ / ~ ,/)& (Z10)
~~.. /" ./~-t ./ r I - -y----" , ~ /" q
~Telep~~e ./' ,/ or Date 7"-'-::-:" ,"7",-'
When penTIlt lS ready notlfy L/ Appllcant () Owner C/ Contractor ill. C/ mall C/ phone
Owner (Z1P) Phone
Contractor (Z1P) Phone
Contractor's OSR#
Plumblng by
If Commerc1al
Resldent1al
# of stones
of bedrooms ~
SI test holes ready
DU NUr WRITE BELUW
# of employees
THIS LINE
# of
SOS
Unl ts
C/ EXlstlng.
C/ Proposed.
BP #
SI #
Fee
Code
Descnpt10n
Sq Ft or
if of S1tes
Unlt
Co<'"t
Va1uatlon
Fee
$ /.// ~
-
/~
$
$
$
$
.$
$
$
\
\
\
$ .#J ~
,-
...-7 ./
d/"'_.d'/d'A'P' _/ Y::::?/ff _/._</J_ "7P
}" j....-v'... ....-r/VY-V-( -~
I
...,...... , ,.
(,.P' --
, ~
() Cash
-,
/./ Check #
"
RecelVed by v? . .J / ot'L.
/1 ' /""~ , ,
Water Supply /
Q 7.:r"
.J
Total Valuatlon $
Plumblng flxtures at $ each
Sewer/water conn at $ edch
SUbtota 1
4% State surcharge
Pl ans check fee
Change of Occupancy
TOTAL
Part , Parcel # Pa rce 1 SHe
Il, slde , lnt rear
Proposed
Year Installed
EXlstmg
PERMIT PROCESSING
M1nlmum setbacks
Zone
Il. front
Comments
To be typed on perml t
By
Ddte
WATER POLLUTION CONTROL
Insta11at1on speclflcatlons
To be
~.".~
V
typed
J-J)
gal tank, . . foOt (Jof dralflfleld, max depth of t!~>>ches
on permlt , Jl.t s Il S: .a.1CkAll ~ a..... ~...t'",
ar..M.;..i' 0 k- ~ /1~A_ :dt.-...._~;t~ dZ~-;", ~~~ .
/TP- U I t7 i 1/
Telephone
BY~
~
j/_-
~- '1- 7(
--""~- --- -- ---
Date
Dlrectlons to slte
----,,~--
r------
-_...--.-------.---- -
D SI!:"Q Pl ans to CP&I setls) Date Hold 511 p
\.0,1 PC - sells) Requ 1 red
\ - to PlC
0/ CP&I .4h"7
,
~ WPC Viii ~
U Plannlng -//'~
0 PubllC Works
0 El eva tlOn U n/a
/~/ Address
- .
C/ Facll1t/ Perm1t
L/ Envlronmental Health
Ddte
COIllpleced
Oa ce to
PCC
FOR INFOPltATION about progress of your appllcat10n call
Permlt Control Center
687-HELP
(687-43S7)
('t.. ~ .
.: ,- ~ (. DEPART/lENT OF ENVIRONI1ENTAL 11ANAGEI~EI ~
'(J PSB. 125 EAST 8TH AVENUE fit
~~r-S EUGENE. OREGON 974~Or fA 0
Job Addr~J 4I~/7!t?d../P) p C1t,r' U~"".A~
,11lWll~~tP. ll~nge.,SpJl(>n, T~<!t //rf'-t:J2 -/J.-S- ~...:<'. I?/ d#
SlIbdf\lHfon It.// h' .,- Lot lIlock
Appl,catlon for- ~__'/""-'.u?f ~ ~#
.. / I
Structures now on the property
Pr,opo$ed U$J1 "f I'rol'<tr1;y, Cf It<tsldentta1' Cf COIlll1e~taJ'
K I U//?/?/'c,e y-
. -{P1e~se print)
If thlS appllcatlon lS for an agrlcultural bUl1dlng ,t wlll be used for purposes allowed by the State BUlldlng Code and
Lane County Code Chapter 10 (zonlng) and for no other purpose I have the followlng legal lnterest In the property
owner of record, contract purchaser, lessee. # holder of an exclu51ve optlon to purchase,
duly authorlz~t ,for__Stl;,~.mej;'77h~ r~dgea~le~0h-'S appllcatlOn
SlgnaturefAddress ~./,-'/ ~./y /' k~./..//~ - (ZlP)
0elePh~pt - - / / or . Date ~-~ 7Y
When permlt lS ready notlfy Cf Appllcant Cf Owner Cf Contractor h C/ mall Cf phone
Owner (z, p) Phone
Contractor (Z1 D) Phone
"IIIl
Appl H,at ion #
J.C - ~7:? -7f-77JlIl-
l\$Slgn~d Number.
Cf 'IndU$tl'ial '
o l'yb1W
, hereby cert,fy that thlS lnformatlon 1$ true and accurate
Affldavlt
I.
Contractor's OSR#
Plumblng by
If Commerclal
ReSldentlal
It of .wri~
It (>f wd."OOIIlS c::z
SI test holes ready
DO NOT WRITE BELOW THIS LINE
# of employees It of untts
50S: f~f EXlstlng, BP #
f~f Proposed. SI #
Fee S.v Ft: 0"
COde lle.crlotlon , of Sites
~-#'~LU?-t"~~.~A'/-~.54- ?,f
I
Ul>lt
CO$..t
Valuatlon
VC::k" ij 7~.. /
Recelved' bY~P'~./A'~
// /
Water Supply
Proposed EXlstlng
Year Installed
Total Valuatlon $
1'1~tng flxtUTe$,at $ each
SeWer/w~t~1' Conn"at $ each
Subtotal
4% State surcharge
Plans check fee
Change of Occupancy
TOTAL
Part # Parce 1 # Pa ree 1 SlZe
t, slde . lnt rear
PERMIT PROCESSING
Mlnlmum setbacks
Zone
t, front
Comments
To be typed on permlt
By
Date
CP&I Type
To be typed on permlt
Group
F1re Zone
Use ClasSlflcatlon
For plans lnformatlon call (area lnspector)
Dlrectlons to slte
BG4/Jf:;J)
U
Date
Phone
'--1-;;2...</-17
Sf/cd)
Pl ans to
set(s)
set(s)
Date
Completed
CP&I
WPC
Date
4?1red
4ff1-
Hold Sllp
to PCC
Cf SIFO
~CP&I
I)f' WPC
C/ Plannlng
C/ Publ1C Works
/~/ Elevatlon C/ nfa
Cf Address
I~I Fac 111 ty Perm1 t
~I Envlronmental Health
FOR INFOP~~TION about progress of your appllcatlon call
C74-171
Perm1t Control Center
68l.HELP (687-4357)
Fee A?
$ /b? -
,
$
$
$
$
$
$
$
$
$
$
$A ~
Da te to
PCC