HomeMy WebLinkAboutPermit Fence 1995-10-5
I'
~
~.
.
-4
SPRINGFIELD
"
FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
.,. I ~ .
DUILD~NG SAFETY DIVISION
'.
225 North Fifth Street Office: 726-3759
Springfield, Oregon 97477 INSPECTION LINE: 726-3769
. . (PA!f)~ f=i5tJC-6)
Job Location: /(/VE~ (;'L Pk 97'T /de /~M2/d 0ecXr
AsseSSOL'S Hap II /? (') :1 2. 'J t:) 0 Tax Lo t I: CJ / 01") ~
/I.;I/'~ C-/e" .L.L.(. ... IAU"'E L.-IA...-I/I"-t.,,)
, ~ J
Address:..l..~) y Mr." ,L"", t1,,;' /2r Phone I: 30)- 93 9'1'
City: Cu,:/~P, J?tf 9'//)61- State: /J""Pjh Zip: 9jyo,~
Owner:
Value of Fence: ,ill, nIX> ~
Fence Permit is $5,00
Contractor/Insta)J.er: It..;I ~r;~_ A46.n)"I!ii_~ "
. ~tr,(, -;:;;:r:;-C'6";;)'( . /
Addms:1JJi/JPlYIJ fJ.,I,LI.(/~&,j Phone I: 7'1(, -:'51.2 V
City: CB /'U';'j State: all Zip: '17Y'y If "
ConstL'uction Contractors Registration I: 6/7 b7 Expires: ~bc:Af. ,:
Dy signing this. permit/application, I agree to call for an inspection once my
fence has been constructed (726-3769). I also stated that all information on
this application/permit is correct and that I was provided with the Springfield
';;:Z;;7I1' Eo, ;"~.' ""''''0 '7/; J/9)
Signature U Date'
, ,
FOR OFFICE USE
. ..,r
..'\
..ion #:
'7 :<5"'//_/1")
Date of Application:
Receipt ff
Issued By:.
Total Amount Collected:
5~C)O
Checked for Dellnquencl es:
L.-----
Checked for Historical Status: