HomeMy WebLinkAboutPermit Miscellaneous 2007-1-1
.,: ,. CITY OF S~ lNGFIELD, OREGON ()
SP~
~ .',,-
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
City Job Number 1:.ovVt e..c>c>7 -Of f::%Z Date
o 1 & 2 Family Dwelling or Accessory 0 New Construction
o Multi-Family 0 Addition/AlterationlReplacement
%- CommerciallIndustrial I2K. Tenant Improvement
Job Address '3" (" IF /"7tft-/o/ f f-
Lot Block Subdivision
Project Name 7 - i:[ I... if.......)
Description ofWorkllocation on premises/special conditions
o
o
Demolition
Other
Bldg No,
Tax MaplTax Lot
Suite No,
r 70:5 5bJZ 0"])0/
, .
nb/~
{LAM (/
o I Pronertu Owner
Name 7- c/~,,<:.J
Mailing Address 1'3 9 t.
City S,rIN~r<clj
Phone
I 1 & .2 Familu Dwellina
SQ Ft X $/SQ Ft
Value
L:
State
/'?,.,.,,,J 5 r
(!);< Zip 9 7'1 77
New Dwelling Area
Garage/Carport Area
Other Structure Area
Total Value
L Commercial/Industrial/Multi-Familu
SQ Ft X $/SQ Ft
Value,
Owner Representative
Phone
Fax
/(V/lo/ t/ /~i,e /1
Fax
o I Anvlicant
Name p".~ ,'r:.", )2.,''''''
Mailing Address 10 /.( 2 'f
City ?c=..-f-kwvd
Phone <;;'D3 319 :Jet?
.J;;Jlcr /lfh2 S
~t:: Ci..e.frv Bfu.<.,~ Dr?
State e>/Z Zip 977-/C,
Fax
Existing Building Area
New Building Area
Total Value
-r/'o
?S""D~
o l ArchitectlpesigneriEngineer
Name
Address
'.
Existing
New
City
Contact Person
Phone
State
Zip
Occupancy Group(s)
Const. Type(s)
Number of Stories
Fax
o I Conlractor(s)
Contractor's Name
?,,/.o ,=,.,. 12.",",
J:;vIe. i dT{ 5
CCB#
1'i6S-1{,
Expiration Date
Phone #
5()] 'OJ 8.,,'7
I 0 I Residential Projects
Heat Source: Primary
.Water Heater Range
Do you require any oflbe following for Ibis project?
Over-widlb or Second Driveway 0 Yes 0 No
Temporary Power 0 Yes 0 No
Notice: All contractors & subco!!.tra~tors are required to be licensed with Ibe Construction Contractors Board oflbe State of Oregon
under provisions of ORS 70 l' and,maY'"e requireil'to-be li~ensed in Ib~ iurisdiction where work is being performed,
~ Qffice Use Onhf~ )
.& :t- CHECK F?E't 7 Z 06 __/_.1 ~GPT# I. 1 DATE
'Fe#' B &LL.D-I-N'G PER M IT
General
Plumbing
Mechanical
Electrical
rM+Commercial/lndustrial Projects
Has site review application been submitted?
DYes 0 No 0 N/A
If so. Name of Planner
Joumal Number
.
Secondary
Energy Path
I BY I
AP PLICA TION
Shared Drive(T:)lBuilding FormsIBuilding Permit Application IO..o2.doc