HomeMy WebLinkAboutPermit Building 2007-10-14
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FAX: (541)726-3689
City Job Number COJ't1 z-oo 7 - 0 IlfZ- 7
% 1 & 2 Family Dwelling or Accessory .-Q--New Construction
o Multi-Family 0 AdditionfAllerationfReplacement
o Co';'merciallIndustrial yI1 0 Tenant Improvement
Job Address '791 5,) 47 -1Z?c'r:'?-
Lot Block Subdivision
Project Name
Descript!on of Work/location on premises/special conditions
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Mailing Address 7'11 50 L/7r:b //L//Ce
Cit.,5;;#/J/7<!'LcI Stat~ oIL. ziptf7L17 tf GaragefCarport Area
Pho:" 7 Lf~ 51 L/ 0 Fax 72t- 'itS:-J?o Other Structure Area
Owner Representative :5'(" L r
Phone 71./1- 391.(0 Fax 7~~'?7i'3~
Date
o
o
Other
OCT
Bldg No.
Tax Maprr ax Lot
4 2007
Suit"<l:i? ." .
1 i~164flGt!t..-O' ',",nro
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Contractor's Na'me CCB# Expiration Date Phone #
Oc..o N'CL4 7 J/ I.( ~ 73 '51/0
----rf3 f)
--r r? 0
Electrical -r"l!3..LJ
o (Co,,-,;ilercial/lnd~stricil.p;.oj'/Et~.:i
Has site review application been submitted?
DYes 0 No 0 NfA
If so. Name of Planner
Journal Number
o .lJ-csig~'niial ~roj~~t!!, ::~;!t~t.~;~':j:~~~~.f~i~"i~t!i;N.~i~~;"$i;:3"l-~~~i~'~.i IE ",;~<7{'i\
Heat Source: Primary Secondary
Water Heater Range Energy Path
Do you require any. of the following for this project?
Over-width or Second Driveway DYes 0 No
Temporary Power DYes 0 No
Notice: All contractors & subcontractors are required to be licensed with the Construction Contractors Board of the State of Oregon
under rovisions ofORS 701 and ma be re uired to be licensed in the 'urisdiction where work is bein erformed.
For Office Use;Only, , " ,,1,:,".]";-. ,......, , ,...X' -I. .. ..
PLAN CHECK FEE RCPT# DATE
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Name
Mailing Address
City
Phone
Zip
State
Fax
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Name '
Addre~s
City
Contact Person
Phone
State
Zip
Fax
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General
Plumbing
Mechanical
BUILDING
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SQFt
X $fSQ Ft
Value
New Dwelling Area
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Total Value b'3 6" Zt'
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SQ Ft X $fSQ Ft Value
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Existing Building Area
New Building Area
Total Val ue
Existing
New
Occupancy Group(s)
Canst. Type(s)
Number of Stories
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AP PLICA TION
PERMIT
Shared Drive(T:)/Building Fonns!Building Pennil Application IO-02.doc