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<br /> • CITY OF WOODBUR
<br /> HIp�,� a- i;,-,,,7±,.. Permit No. H ` ( C
<br /> '270 Montgomery Street Woodburn,Oregon 97071
<br /> WO OD R T T T (503) 982-5250 Fax(503) 982-5244 RECEIPT NO. '1^1 -2 _rf, -I li / /
<br /> 1� �,J l� Inspection Hotline: (503) 980-2443
<br /> Incorporated 1 8 8 9 UILDING PERMIT APPLICATION DATE RECEIVED i g r.'; y' j
<br /> ❑ DEMO PERMIT ❑ BUILDING PERMIT ❑OCCUPANCY CHANGE FORM AMT.PAID S Cif ds0,
<br /> ❑ SIGN ❑ FENCE 0 MANUFACTURED HOME PERMIT RECEIPT NO. =f 2 -,--i g .i:'.R r'"
<br /> BUILDING ADDRESS: I % I -
<br /> (3 t J DATE ISSUED 1'•. '°°'
<br /> � 1 � • liil C t I J+_+ �� '41���°
<br /> LEGAL DESCRIPTION SUBDIVISION: ti a `2 r -
<br /> �' I r` l
<br /> ( `- , C! l I�r,t I ,‘ t. / t_• f"I •- +,-, i f C AMT.PAID Si
<br /> / �, _..:L ..e •9_�/1.;3
<br /> LOT:# TAXACCT#: (':ter %LOT COVERAGE ,..- BuildingPermit Fees:
<br /> / 0 eply`/�__D ,,..,
<br /> i w r
<br /> MAP NO: - ,- `` . -et d AREA OF LOT: ,, '` / ''~ .C-� ''. \
<br /> i '' t I. 'd an, ;frt.'e.."' % / / L. BLDG PERMIT l•1 if a ('
<br /> OWNER: PHONE: �, S I--'
<br /> I :4 (_- v • C C,c._; I r • ,_` - \ •
<br /> PLAN CHECK ,} I s '-' !
<br /> MAILING t `` --
<br /> -
<br /> ADDRESS: �)~ 1' 'c, . i 1 :1 ;; ' J'I C-- FIRE,LIFE SAFETY
<br /> STATE: .CITY: ZIP:
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<br /> .-• 1 , ; • +. I i _ ._ :. --• '� STATEy�y Al / / )
<br /> CONTRACTOR: :1� .` , fit 1 i f; j i PHONE: ,.''' . .°a` 3i. E °'' 1�t
<br /> c t: '' Ili' ( 1. -
<br /> STATE OF OREGON BUILDERS BOARD CERTIFICATE OF REGISTRATION NO:# i r ; .• .4:
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<br /> 1 -
<br /> ®� -I'd`1--)—1; —e v ❑MECH PERMIT
<br /> c' d
<br /> MAILING + I
<br /> ADDRESS: .: ; t..l% • . itl PLAN CHECK
<br /> CITY: STATE: - ZIP: ,
<br /> i , /; (-.. _.
<br /> STATE 7%
<br /> PLANS DRAWN BY: i: i PHONE:
<br /> MAILING
<br /> t�de
<br /> 6
<br /> CAITY: STATE:
<br /> _ = STATE: ZIP: .14�MOBILE HOME / 1 1
<br /> N, t`� � f '�>
<br /> STATE FEE 01
<br /> ❑SINGLE FAMILY ❑MULTI FAMILY ❑COMMERCIAL ❑INDUSTRIAL )
<br /> STATE 7°/a`'iJ ,
<br /> ca NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑ REPAIR ❑ DEMO ❑RELOCATION I 0 ,+'✓ 6 (. ./
<br /> SET BACK:FRONT YARD . + RT.SIDE REAR YARD , LT.SIDE ❑MISC.
<br /> SIZE: FIRST FLOOR -, y LiSECOND FLOOR
<br /> BASEMENT GARAGE i Building
<br /> NO. BEDROOMS - HGT.OF BLDG. , _ - HEATING: ❑GAS O ELECT. Total:
<br /> SPRINKLERS NOW NEW ALARM NOW NEW Development Fees:
<br /> JOB DESCRIPTION /' + TECHNICAL& !i/ c' ,,
<br /> • I l ! ! 3."/'>' + / , '/.'. : , 1 , , r: r +-- - ENVIRONMENTAL /d _
<br /> Ne 065)
<br /> __ SEWER SDC 2 i. .�'1 7
<br /> ``` ALL SURFACE STORM WATER SHALL BE DIVERTED FROM THE BUILDING SITE AND SHALL NOT DRAIN ONTO ADJACENT PROPERTIES. PARK SDC j Lf(/ ?
<br /> SEPARATE PERMITS REQUIRED FOR PLUMBING,ELECTRICAL,AND MECHANICAL -
<br /> STORM SDC 1- t: •
<br /> OCCUPANCY GROUP: TYPE: VALUATIONS:$- .00 ,s...
<br /> 1 '' C- i.;t •• fa u) I.
<br /> 1•�-t -- cl TRAFFIC SDC 2 's : `( ,
<br /> I hereby certify I have read and examined this application and know the same,,}o'Ee true and correct.All provisions of laws and ,-^ "',.° I
<br /> ordinances governing this type of work will be complied with whether specified herein or not.The granting of a permit does not WATER SDC {f;r
<br /> presume to give authority to violate or cancel the provisions of any other state or local law regulation construction or the performance �- -
<br /> of construction.THIS PERMIT BECOME NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WATER INSTALLATION
<br /> WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT t" t \` •
<br /> ANYTIME AFTER WORK IS COMMENCED. R/W PERMIT amyl,0 ��
<br /> APPLICANT'S NAME: (PRINT) i; !L L i i' : i �,.:-i CELL# - %4
<br /> i` ) WATER DEPOSIT ' f i,f-
<br /> APPLICANT'S SIGNATURE: .-• / 1 / ti I `ki\,.__. `N,.
<br /> SDC Total: 184(,- tr'3 1 0
<br /> SPECIAL INFORMATION AND CONDITIONS•
<br /> Ce4 hh
<br /> 1 No it
<br /> 1
<br /> APPLICATION APPROVED BY: ?
<br /> DATE:
<br /> White Copy-FILE • Yellow Copy-CUSTOMER Pink Copy-STATE
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