HomeMy WebLinkAboutPermit Building 2008-4-10
Si'\r"E' AS.
1(;.'33 .5 5€4"'-
225 FIFTH STREET . ~J?G~IELb, OR 97477 . PH;(541)726-3753 . FA-X; (541)726-3689
City Job Number ~ .~~ Date
~ Nen' Construction
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OA sMJ, '",-v-. .
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1 & 2 Family Dwelling or Accessory
lVlulti-Farnily
.CommerciaJ/1 ndustrial
Add itio nl Alteratio n/Rep I acem en t
Tenant Improvement
Job Address
~7U?
Block
Subdivision ;}"'-'ty("
. I
Lot .201
Project Na~e
Description ofWorkJ]ocation on pre~ises/special conditions
o Properttj Own?]' .\..",;i,;,;;;f.rr" >\.
Name /-J ~c-Il'f\ ~e S
Mailing Addr:ss d'l" C/ 5w 6/AClu PI.
City Kc.,frn,-,,-,,-A State n tC Zip 'f77SG
Phone 54/-J2q-(,q~., Fax '741-a-S7?-
OWner Representative
Phone
Fax
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o Appli';,{nt
Name... ILvrl",-; J-hn-1,,"~
Mailing Addrtss p,.O &v 0f3
City 5?/-;~ re.1oi State . Zip
Phone ..;;qI. -2R'i? -c,q S.':- Fax 74/,;)$ 7;;J
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Name I-k;du-.. !Ioh7~ . f j A ChD
Address . .
City
Conta.ct Person-
. State
Zip
,:",,';..0;
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Demolition
Other
Bldg No.
M",,", ""6 Tax Map/Tax Lot
Suite No.
'/~iFiziTdIYDi~elliilg .
SO Ft
New Dwelling Area /cJ'3/
Garage/Carport Area 40Cl
Other Structure Area q J.L c:...,
Total Value . \\ -\. ~
~::i:':~!;~~\~:~i..';:E'}{"':.c{!.:\/:_':',,-..' ., '. \.. "._"
U]l!1Jt.rjt~!'GlaVlildll~lriflVMulti'Family.. .. ...
SO Ft X $/SO Fl Value
X $/SQ Ft
Value
ExistingBuitding Area
. .
New Building Area
Total Value
Existing
New
Occupancy Group(s)
C onsL T ype( s)
Number of Stories
Phone Fax
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Contractor's Name CCB# - ExpiratIOn Dat~' Ph~~e #..v_ . ,..". .... -
General !/.u..d,'7 /*-'".. ...
Plumbing tl2t4ti" PI(Jn-.Ar-,. .
Mechanical Pev, ~r J1,r.- {t'1.....~f-
Electric~1 7~:A1&h-h-. ... "
o ...Com;nercial/jiidu.si;r:ia.l.PjoJJ~i~';;
Has site revi~w application been submitted?
DYes -0 No 0 N/A
If so, f:Jarne.ofPlanner
Journal Numbef
[gt )lJ~siMntii:J,lI):ojec.t'i(U;;'
Heat Source: Primary (", II;. "-;.
Water Heater -1,,<, "-. Range
Do you require any of the following for this project?
Over-width or Second Driveway 0 Yes 1)!3 No
Temporary Power iii Yes 0 No
Notice: All' contractors & -subcontractors are required to be licensed with the Construction Contractors Board of the State of Oregon
under provisions ofORS 701 andrn~Y?e reQ0!e~ !o be ,licensed in t~e jurisdiction where work is being Derformed.
I.For Office Use..Only'. :;.-.,-./...:: -'.. "..-jY," ''i-,.. ".::. ,;.:"<:.. .... .. ./c,.;... . ... ..... . . "'/. .,.
I PLANCRECKFEE I I RCPT# I I DATE I
PERMIT APPLICA.TION
BUILDING
Secondary
Energy Path
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Shared'Drive(T:)/Buildin!; FonnslBuilding. Pemit Application 1O-02.doc
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BUILDING PERMIT CHECKLIST - -- ~
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Lo + ,.J oC(
I Lot SiZe
I Zoning
I Plan Designation
I Metro Plan Designation
I Building Height
Solar Setback Approved
Percentage Lot Coverage
. I Willamette Greenway
I Hillside Development
.IUF-IO '.
I Historic
I Flooq.Plain Zone
I FloodPlain Panel
I Floodway
I Wetlands
I [r\ J. T' T\. 'l" T_ .---}- _..
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. I Tree Felling I
. Setbacks f JJ/g.2~.c;
(house). .s J /"1.$'S to
Pave Driveway .
I Number of Street Trees
Prior J oumal Numbers
K -~1-0'G::,~ J
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L\)\R
Setbacks
(garage)
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Comments
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I Plan CheckFee Entered
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