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HomeMy WebLinkAboutPermit Mechanical 2003-9-26 (2) 225 rIITI-f STREIT. SrRlNGFlLLD, OR 97477 . rH:(54 ])726.375:~ . FAX: (54 ])726-3689 ~: OJ . r' Job Location ~' Assessors Map U; : '1: Owner"h"" -e~&s .~; Address 7,QCfIe 1<,'Lh/and. f';/. ~. ~~ ~; 0;, . I""!"'l' ~: U; , v; ~. r.f!ll Ci , ,~ ~I ~) ;.;....~ Qj), Vll ~. ~_.~..( ............... Qj): ~, 0\ ~; 00) .,/ .-. ~. 'Va.'; , ) 01 ~ . . ~~l'~~ .''\ ~.r;"'GITY::GF.SPRlNGFIELD, 'OREGO~' "';'>~~:f\~.~~ .",~"" '~ " ,.; \ , >. "" " City .Job Number CoWl 200 -,} -GO 9'7-) ?-,qtft f</u~i ,<, J- J g{)Z D6c.{ I <v~l tJ,(., Cf7o/78 0670-0 Tax Lot Phone fSc;;j 7tfj-tJ79'i Z. q, '1'1 'g Ip City ~/,,;/}JJMtf V Value of Wood Stove~nsert: tJ,L State :/'290.8%? (please circle appropriate appliance) Preliminary Inspection is $45,00 (prior to insert) 0\)\0 Wood Stove/Pellet/Insert Permit is $62,65 (inclndes Permit, Issnance F&S'~Sfa't~\\~harge & Admin Fee,) , \~'" ~a _ 1,.(\0(\ ~.,M~(\ 0\' - ~ev S0"~ J:fJ ~o~a~ 0\)'1" \)\0&~Q.9CEJ~ \ ~,\\O '009\'a '(\oset :t\O..... (\)v;J'J> t:: IU\a&~ (\\0I,iO\'l\IOU~0S0\\~9'l\0(\0 (\ Contractor E/Yle/"Cl.W ~I d- -4 1<Il "\0(\c:r-...t:f:J\_)<\c09~..'(\e\dI_.\~ce.~0 I OC.... '~~./ n/7_ ~I NO\\'\;~9f';)?; ~~'l0~~.\..~0'~\\\\~~:4'" Address 5 /J..;} hV~1 '-r'-7 ft,/, ,0 "1"1 -",(\ ....tPh0D'9,?:yr' I O' ~.. ~ Q\uO ::,-.J- )~flJ '~\(\~" ~ ror::FY Cit" ~ ce.~ <otafe\O. \S\- Zin Cl7C!tJ;) , "(.,. l\U"l"U ee' - , Construction Contractors Registration ii Ct;.lj # j 1294/ JOxpireo /{)- ZL-CJ'5 COli tractor ll1fol'",at;oll By signing this permit/application, I agree to call for an inspection(s) as required (726-3769). I state that all infornlation on this application /pernlit is correct and that I w~i:vided with t~le Wo r-~ information for wood burning appliances and prelimina,' , n sl~ fi\'"~~(JIkpartment of Enviromnental Quality or the Federal Environmental 15~atA'i!e rle\\ ,,:t!\& &J p\v~he testing approval number to the inspector at the time ofinspectio, ~\m'\In& 1ct118~_h'estlllg a preliminary inspection, the wall covering may be require \\1'MHtl:l\i.&I0 100, C .. aQ Op.'{ Pt.\\ p.~'{ 'u cd~e/I I~ Signatu'p C/ ~t.$'l /( Date ~/ :Z~/d 3 For Office Use Date of Application 9r-2!b -o'? V' Checked for Historical Statu~ v- Checked for Delinquencies Shared Drive(T:)IBuilding FonnsfWood SIOVC Pcmlill.:oJ,doc