HomeMy WebLinkAboutApplication APPLICANT 6/27/2007
City of Springfield
Development Services Department
225 Fifth Street
Springfield, OR 97477
Final Site Plan Application, Type I
Site Plan
Review:
0'
Site Plan Major [g]
Modification Type II:
Site Plan Minor
Modification Type I: 0
Applicant Name:
Company:
Address:
Steve Ord
IpaCificSource Health Plans
1110 International Wav
IJohn Bramwell
1 Robertson/Sherwood/ Architects pc
1132 E, Broadwav - 540, Euqene, OR
I PacificSource Health Plans
I PacificSource Health Plans
1110 International Way, Springfield, OR
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Phone: 541-684-5233
IFax: 1541-431-3806
Applicant's Rep.:
Company:
Address:
IPhone: 1541-342-8077
]Fax: 1541-345-4302
Property Owner:
Company:
Address:
I Phone: I
]Fax: I
....'..
ASSESSOR'S MAP NO: 17-03-15-40-00100 TAX LOT NO(s): 100
Property Address: 110 International Wav
Name of Project:' Emerqency Generator Installation
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Description of
Proposal:
Site Plan Modification for.emergency generator insta,llation.
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Case No,:
Applicatioll Fee:, ". _ ,~ .
:
l)r2 ( /JDl - Cx5'b Z-=r
Date Submitted:
Reviewed by:
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Associated Applications:
I represent this ~cation to be complete for submittal to the City.
Owner: I~f? /<<--- Date: b/2S/o'=r-
(Signature) , /
t(C2N,J6/f /? ~V~
(Print)
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Date Received:
~/;:: 1,12007
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Final Submittal
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
'r'..y of Springfield Official Receipt
~"velopment ~ervices Department
Public Works Department
Job/Journal Number
ORC2007-00027
ORC2007-00027
Paymenls:
Type of Payment
Check
cReceintl
RECEIPT #:
Date: 06/27/2007
11:06:10AM
3200700000000000433
Description
CTY 10% Final Site Oev Agnnnl
+ 5% Technology Fee'
Amount Due
382,20
19,11
$4U1.31
Paid.By
PACIFICSOURCE HEALTH
PLANS
Item Total:
Check Number Authorization
Received By Batch Number Number How Re~eived
Ij 0 10340 In Person
$401.3 J
Amount Paid
Payment Total:
$4U1.3]
Date Received:
~~;':J:f/ 2007
Original submittal
Page I of I
6/27/2007