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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