HomeMy WebLinkAboutPermit Building 1982-7-16
rq
, )
~
( ,
,
~
CONSTRUCTION/PLACEMENT
PERMIT
FOR OFFICE USB ONLY
TOWNSHIP
17
RANGE
03
PLEASE USE BLACK INK AND PRINT.
Tla~)~DOUT OF
LOT/PARCEL BLOCK
SECT I or...:4~
Application/ Cc'.'L r. /)
Permlt# \~O:}""i)(J
[]Two Copies of Plans
[] Two Copies of Plot Plans
[]M~chanical Checklist
[] Plumbing Ched:list
, OPlan Check Info Sheet
COMPLETE THIS BLOCK.
~UBDIVISION/PARTITION (if applicable)
LOCATION .'1DDRESS ""~\ STREET " t' '< CITY ZIP PP.OPOSED US!':' ClF'. P20PERTY I
~)4~~1 1.7(;tldl...K' Y L.(I t lJ L.w~ ,,";'>:rJ~i 0Z(1~p Q1Cidential DIndustrial
STRUCTURES!CURRENTLY ONw:.R0PERTY' {iJ ,~""," ~ .{J' :' l (
ti'Kl "JltJ"'YX"''::)! rYlte .~~qalnLl tA t>')Cf ~(lfl ~rYl -
DESCR-IPTION. OF PROPO~ED jWW K..1 I """'. 1 ~ . I
~"I <' J /llll "-"":1 . J, -1' ." I" ..... Il A ....,.,.I': I _L ~
......_B J.....11(..),.., ~~, L. '{ ( .( Ji( t L~.flJ ,J't r. ,ft.r..,l
!; OF BEDROOHS l # OF.l.S!j.'JJ RIES. ' # OF('EMP.,l;~.\ YEES WflTER s~..p~J;Y . . D~oposed
#t.j ~M t"'il fl.. _ ({~ "VT}(J ?rH ) 'YAc ~ Existing
O\'iN7R'S.NAHE AND ADDRE."::;;.~~,^nq ~'II),!!It.\....-' .1 r.;'~ " j \ [' . ,..JELEPliONE NUI1BER c 1
1,'\(}L;C\'r. L j~r;O.'l'1..~ J'tl1.ryn.k":J\. . ('/~4w7 (~7t11rll:y vi OJ -,) ! N, 747-h7'~
CON~r" F,f".CTOR' S NAHE AND'.i;DfJRESS I ..).-.- _ '.. ' -v\ LIM /~. LJ .' r') '7".,-, ,.. TELEPI{or\E NUMB~!{ - ,
CXtiTWJ C!;')~ OL.:{)l}€, ',,", AJr ( YYA/\ lCTU "' ( )f{(C-t'-'r (?- (,.77
CON'lIf,",CTOR'S. GSR # I(}FECTIONS TO SITE; ..,/ f' <...J.. k. ~ .'. ,_J_ V-....i 1 \ J \\.1"""., t .
!7J ,CroJ C5ri rcsc~l f It rlL~ "l-~\.~~'lnCI ;~'ar Fn ~~ ) ~LL~ t~l J\bri 1\
c~n E!tClrlrytlnS ''1.0ltJdr Pd.: fu;A if) 1;::'911111 VI Plly-h tl1 n .
t I Hl\VE CAREFULLY EXAMINeD THE COMPLETED APPLICATION FOR PER!-IIT\-and do h~r<~bl rr'rLlf" thcl\\.",,'~"l lnforl111tlolll'lC'Ic:rJn 1-, trllt:? Jnd C'Otlcct and I fpl:.llv'r
: certlfy that any and all work performed shall be done .In''''''~ccordance wlth the Ordllli:3 KCS of Lane County and...t.h '~a,...s of thl:; SLate of UJPlnll I ':;'l<1lf1II1'J
! to the work described herein, and that NO OCCUPANCY will be made of any structure without the permission of the Building Di.vision. I furth'.:!r ccrti fy
that. registration with the Builder's Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exempt.ion i~ notf'd
~~~~~~T~~~ ~~~~O~~~~/~:l{f~n: da:Sf~{~,~,e;1Q)\WlCQIF1,.055 wlll be uspd on thIS proJect, I HAVE READ ArlO CIIE(;:m THIS
I,D 1 (' o "'''',e)
)( "D', nlA S. C ((,q mE R 'l( 9-A.P/h.,b.,..;t(J. /1r.flYl-Pl [] ~o:';:r.l~:Cc'"
D Commercial
o Public
$ VALUE
NAME (please print)
SIGNhTURE
D.~.TL
o Agcn t
'I... '"
o PLANNING/ZONING:
... 1"'/'.
Zone l'i t"--'\
lJartition
Parcel n
Parcel
Size e.[~,(7
".
Hinimum Setbacks: CL, front.
C .
L, sJ.de
interior
rear
Commfnts: Nf.) l ),}(1'n rn nil Llr'14 (j() 916(1 (j t N orL
\ "ry \ ~Ii ~~) . I . ~ "\.) - --
--.- r .. .~., ---- - .-.-----
o FLOODPLAIN: In flood hazard area? D No DYes, see attached sheet.
[] RURAL ADDRESSING:
o SANITATION:
rill>flIAfn;;
. . --~- ..... .. ,-
r-.... ,'- -,.rJ'
Date: 1" f ). r:V".)
Date:
{fVl"
, LLJ
'......_-~~.
o
D
GRID COORDINATE
N
E
Date:
S. 1. #
B. P. #
Installation Record Issued? [] Yes D No
Inst:allation
Specifications:
Gallon
Tank
Lineal Feet
of Drainfield
l1aximum Depth
of Trenches
Comments:
Date:
r
, .-
CONSTRUCTION AUTHORIZED BY THIS PERMIT
Description
1U1PJj(l(C
W lM')l.t
r
Sq, Ft.
Fixed Fee/
Unit Cost
Floodplain Fee
Subsurface Fees
Building Fee
Sewer/Storm Drain/Water
Plumbing Fixtures
Mechanical
Plans Check Fee
State Surcharge
TOTAL FEE
$
$
sti
s
s
s }L1.(;V
A ......;'F..
s ........, ,r< ../
S ' ,';'7?~
s :~J~L ~7
"'. ""-
PERMIT APPROVED BY BUILDING OFFICI.Z\L/DESIGNEE
\;.
LANE COUNTY DEPARTMENT OF PLA.."NING & cor-lHUNITY DEVELOP~tENT / 125 EAST EIGHTH AVENUE,
IX I (It-...... ~
\J\.J lA,:-."\::t1
(;,,,r. ORS 456.805 (1) j'
FEES PA:r;D, BY: 0 Check
r \ ,
By :\--.J1J'l9( ~
Date: 71t~J ;17)
'I, ,
,/
o Cash
TOTAL VALUATION
s
. ..
t .~.
! lJ 1 \~
...\ "'.
- DATE
<'r "'\
X c-l.._
,;.
EUGENE, OREGON 974'01
SEE REVERSE FOE INSPECTION INFORMATION