HomeMy WebLinkAboutPermit Sidewalk 1994-6-3
III'*:>
RESIDENTIAL - COMMER.CIAL
. :~~~~C~~;T
2250 NORT~ FIFT~ 5TREET
5PRINGFIELD, OREGON "11411
ENGINEERING. DIVI510N
OiTICE NO. 12&-31503
IN5PECTION LINE, 12&-31&"1
JOB ADD~se. tJ?
A55E550R5 MAP NO."*
~t1L MAIN
\1 t)Z- ~<-f '3?
CA5H
RECEIPT NO,
TAX LOT NO:"* !;{ 0
5UBDIVI5ION,
C~ECK
OU.NERo
ADDRE55,
"!!?co-r-r
'37 S5"'
oIL
'P n e:, ~ 11...[$
'E;M~eALD'E:,7 CITY, i2:f)~"L
zlP,QfZttfos PHONE NO'v;<{7;'<:&f:, 7
'>if
C~ECKED FOR DELINQJENCIE5
5TATE,
llJORI< DESCRIPTION.
: -----
I 5IDEWALK, - CURB 51DE -
I CURB-CUT, RE51DENTIAL _
I SECOND DRIVEWAY (SEE TRAFi'IC )
I REQUlRE5 AFPLlCATlON FOR A 5ECOND DRIVEWAn'T-4.1.)
I OR A COUNTY ,l,PPLICAiION FOR FACILliY PE~li (C "lIl-203)
IF IN THE U.6.B.
SEiBACK _
COMMERICAL _
5IGNED,
DATE OF APPLICAilON
DA. TE:
WORK TO BE FE~D BY. OIlN!:R
CONiR.4CiOR'>if \N 4L IS CDf4C.f2.~.:1,t;=-
ADDRE55 qLfS- N. ?~ tit ~
v---- CONiRACiOR
"*
REGI5iR.4iION NO. /J()'2.S"C>
SPRINGFIELD
I,?I(, g
~Ifr
*
13:,g~
b /'?-/ClLj
EXPIRES, / / ho/c?4
P;.lONE, "14c'--3!i'a73
r~c"".JRE FOR INSPECTION ~QUE&T.
CALL 12&-31&"1 (RECORDER) 5iAiE YOUR CliY DESIG~iED JOB NLJ:"1BER. JOB ADDRESS.TYPE OF
IN5PECTION REQJESTED A'"D WHEN YOU WILL BE RE,l,DY FOR INSPECiION, CONiR.4CiORS OR OIlN!:RS N.L."lE A,"D
P~E NUMBER. REQUE5iS RECEIVED BEFORE 1,00 A'1 WILL BE MADE THE S""'1E DAY, REQJE5iS -'FTER 1,00
AM WILL BE MADE iHE NEXT 1lJC>!iil<1NG. DAY
"* 5EE BOOK
EXI5ilNG: BUILDING. PE~li NO. ( IF APPLICABLE)
YOUR CITY DESIGNATED JOB NO. Isf
~QlJI~D IN&FECTJON&
~5IDEWALK I DRIVEWAY
FOR ALL CONCRETE PAVING WliHIN
il-lE 5iREEi RIGl-li OF WAY. iO BE
MADE AFTER ALL EXCAVATING
IS COMPLEiE AND FO~ WO!<!<
AND 5UB-BA5E M,l,TERI,l,L IS
IN PLACE
D
FEE&:
SIDEWALKS
.1"'."'''' + ."'.1!;/LF. ( X )
OF WALK
CURB-CUT
.1"'."'''' + ~.1:;/LF. ( X )
TOTAL FEI't1IT FEE.
NO f~ PeJL ~
s 5"0. ~ ~I~ttf
COMMERICAL DRlVEWAY5 S~ALL
HAVE 5>' iO 8' FLAIR5
3'- Oh 5T A'lDA~
940<66s
qLl6M~
CURB I ,l,FPRO,l,CI-I APRON,
AFTER FO~S ARE ERECTED
BUT PRIOR TO POURING
CONCRETE.
WALK X'
/
l
.,
'"
X' J.
I HAVE CAREFULLY EXA"lINED TI-IE COMPLETED AFPLICAilON FOR PE~li. "'ND DO I-IEREBY CERTIFY 7H"-T ALL
INFO~ATION HEREON IS T"'-'E A"D"CORRECT, A'"D I FURTI-IER CERTIFY TH"-T ANY "'ND ALL WO!<!< PERFORMED
5HALL BE DONE IN ACCORDANCE WITH. TI-IE ORDIN"-,"CES OF il-lE CITY OF SPRINGFIELD, AND TI-IE LAW5 OF i"E
STATE OF OREGON PERTAINING TO TI-IE WO!<!< DE5CR/BED "ERE/N, AND THAT NO OCCUPANCY WILL BE M"-DE
OF A"Y ST"'-'CTURE WITHOUT PE~ISSION OF TI-IE BUILDING: DIVI51ON. I FURTHER CERTIFY 71-1AT ONLY CONiRACTORS
.<.ND EM~5 Wl-IO ARE IN ~PLIANCE WITI-I ORS 10'-'*5> WILL BE U5ED ON il-l15 PROJECT.
/~~h~V ~ 6hfci.t/-
SIGNED_______ ". DAiE' ,