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HomeMy WebLinkAboutPermit Mechanical 1985-7-1 If ((Pcl{ '7-/ I~ \ I-'~ FOR OFFICE USE ONLY Lane County -::p'~~~~ization for: APPliCatiOrt"'" 51'- ~~ClS- -~J~.l.nrQJ't' L.t)it-o)U. U~ ..,...,.:..v...../ '. . , ~.,., -. .. - SECTION j TAX LOT...... DOUT OF - PRO~OSED USE OF PROPERTY 28. 3.'1 Pt:JC(J @Re,sidential 0 Industrial I LOT/PARCEL BLOCK , 0 Cormnercial D Public. RANGE 03 ~ . TOWNSHIP SJBDIVISION/PARTITION (if applicable) ...t/ 399ADD~,~~1 ~ n-V~tQl.d . .'P;\#' 5~I'eRT' OJ ~~ C0kY1 ~ n~~~~ ~vd. -b ~ 3m f?1 ~ ~ 6n (Qkt~ ~ ~PTItcru:OSCORK_~_~:~:~^bh- dJnd ~~J\fLXbJu YWotiJLLARED S VALUE '::!.lj~ROOMS # '}a:;;~t<~ \ f,.U V.' # OF ENPLOYEES 1ATER SU~ __ ~:J Proposed If lk...QD .J un~ ~ ,1))(\(ITU >X Yxisting O"'::c~~~~Q ~~~/~~. ........ . ..... 'AX~~,"CAND,"D""4131 't:" OV')~' ~ . ..... I HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATION ~'OR PERMIT, ar,d do herelJY cettify that all ,nforlllat,on hereon is true and corr~ct, and that I have the following legal l.nterest in the property: Downer of record; 0 contral t pllrchaser N7f'authorlzed agent ~~o'"r..o ::-f rl11thor; tv at ;s.;.,"~-:...l, I f:..rther cert~fy that any and all work performed shall be done ~n accordanc8 Wl th the ordl~ of Lane County and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUpANCY will be made of any st,ructure without the permission of the Building Division. I fur- .ther certify that registration with the Builder's Board is in full force and effect as resuired by ORS 701.055, that if 'exempt the basis for exemption: is noted hereon, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. I HAVE READ AND ' CHECKED THIS I~PPLIC(lTION 'fl!OROUGtlLYt. MIt....ha..t Ii O. Of-~""<;tl.-lCc. ,c--y I nNl.-< ( t'l\Jh-<;'M(~ 1.\ I) [)UM\Pr> JI I J~~ ~- NAME (ptease print) SIGNATURE G~ (' /' . \ '- +0 ;-l - X s..' DATE .. II ..... _. "'-_., l . . ,,;...., ~.. . I ,. .,.. '.. .j~... I ..,. ......1_ ,,," READ THIS SECTION CAREFULLY. YOUR AUTHORIZATION ~AS BEEN BASED ON THE FOLLOWING CONDITIONS~ [] PLANNING/ZONING: Zone Partition # Parcel # Parcel Size C C . ' Minimwn Setbacks: L. fr9nt ,. L, side . J.nterlor rear """"'T' ~ ~.c.taU.....Oltll'\r\1 hO &1'11"1'1'\). 23QL CU ~() 1 ~C0 -35 (Dtt.unb1-n6 p:t)' n.'.,t}U-~ \ I IGt?t5 ~\ o SANITATION: S. I. # B. P. # Installation Record Issued? 0 Yes 0 No ; Installation Gallon Lineal Feet Maximum Depth Specifications: Tank of Drainfleld of Trenches COMl-1ENTS : Date: n o PLANS EXAMINATION: COMl-1ENTS: J}J. @-J.L .aLL FeR ~9.UJ ~EO use"irE="~ ~~J.JM:I:;. UI/771 APPRovED FLuGS ~ A ne:<OOA I~ r~u.\1jc.Ls-LiLJ?- ,/ JtJ-cr:PECtlo"u..5 Type Group Dat.e: 7-9- ~ ~~ " ......,... II..., _., . "'", I, '_..1lI 1,1. ..II..".. I .,," ~ .... .. II~.. . 1,\ . 'PI kE 7 -~~~ PERMIT APPROVED BY BUILDING OFFICIAL/DESIGNEE (per ORS 456.805(1)5 DATE LANE COUNTY DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061, 125 EAST 8TH AVENUE, EUGENE, OREGON 97401 SEE REVERSE FOR INSPECTION INFORMATION C 14-25 R84- II