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City- of'~lem '~~ ~~C~ ~ <br />•~ <br />' Public Wo~lcs D rtment C' of Salem CONSTRUCTION PLAN REVIEW SERVICE <br />.. <br />~ . <br />' <br />_ <br />', : . <br />. . <br />Devebpment Se~vic:es : . .: <br />58&+6256 :: s~ts/San'dary SewedStorm SewerNVater <br />555 Liberty Street SE, R~, ~5 <br />Salem. Oregon 97301-3503 ;~ ' .. ~ ~ ~ , <br />Telephone: (503) 588-6211 <br />TTY: (503) 58&6292 : (pem~it aPplication cente~ . . . <br />.. '. Prrojed; No. - . 5 d. 3 y <br /> CONSTRUCTION.PLAN REVIEW SERVIGES ` <br /> Reference: ~ SRC. Chapter 77 - Streets and P.ublic Ways~ <br />City Standatd Constructio~ Specificatio~s; City Design Standards , <br />APplicant: y I~~ ~ k ~e ~ o s -r ; / ~ ~ i /. ' t~~ ~ ; S ~. .. r . Telephone ', ;~ ! - ~/ /~ ~/ <br />~ Applicant is Engineer <br />Address: (~ ~ i -~- a -% C ~ .! u ~~'~. t~ ~ ~1 "7 3 . <br />t D Property Owner. a•; .~ ~ lr l .mu ~a/Ir s f~'~ "~`T'elephone 5"f> ~"~ t~ y S `~ ~~' 2`~Z y <br />Address: ~ N S 1 n1 c. ~~.,~ r~ "~ ~3o j~`~O e~l kl~ ~J~ _ -`'a ~,~ _.~. 0 2 9 i 5c~ <br />~ Engineer. Iti~ F' S-1 P i~ G, ~~. .~, ~ Telephone S~`~ ~~ y 7~/ <br />Address: ~ ~' ~/ ~ ~ ii ~ i ~ t° ~..~ ~ ..a ~~ 1';~. `{' . ~ ~~ - ~l c /vo Sf/ J'J. ..~ OR <br /> <br />Project Name: l.~; 7 <br />i. w-~ ~i .x~ S 7 l~.,~ ~,~ P g~~` <br />Project Address: 5~ ~ ~~ r. r-~ 5~ n) ~ ~ <br />SANITARY SEWER PID No. 6 5 8 3 2. 0 2 1 <br />Plans Approved By: Date: Service Fee: ~i ~ G' c/ ' <br /> <br /> <br />Tap? ~ Yes _ No. ~G <br />~ <br />Engineers Estimated Construction Cost $ 1~~1~ y'f--°'~' Remarks: 7~ :!~ G~ <br /> <br />STREET PID NO. 6 5 8 32 . 0 2 2 <br />Plans Approved By: Date: Pennit Fee: n ~j ~~ y ,~~~ <br />~° . . <br />Engineers Estimated Construction Cost $~ 7i ~ 1 4/~y ~- Remarks: -. <br /> <br />WATER ~ ' PID. No. 6 5 8 3 2. 0 2 3 <br />Plans Approved By: Date: ~ Pecmit Fee: $ <br />Tap? _ Yes _ No. Engineer's Estimated Construction Cos~ $ ~ .Remarks: ~. ~ <br /> <br />STORM SEWER . PID No. 6 5 8 3 2. 0 2 5 <br />Plans Approved By: ~" Oate: Permit Fee: $ 7~ 7. <br /> <br /> <br />, Tap? ~ Yes ~ No: . -~ V <br />o.°-:.. <br />Engineer's Estimated Construction Cost $ ~ ~ ~ ~ ~ Remarks: ~~ ~ ~ ~ ~d ~~ <br />~~ <br />ARBUCKI <br />~ CQ~T Total service Fee~ rfiis Page~ ~$`? G Z.~ U v <br />- <br />. <br />. <br />. _ :. ; . ~.. . <br />,4ddi~ona~ Sen~ics :Fees: ~ $ ; : ~ <br />JAN t 519~9 ~ . . ~~,'F~ $ ~ ~o . <br /> ,Prooess~ng Fee, ~ . <br />~.: R E~ ~ ~ V~.~. Tota1 Pfiyment .$ S C3 ~ <br />APPI'icant Sgn~ture , . . : . , . ; . . . ; ~ . : ~ ~ . . ~.°: . bate. , .; <br />. . .. <br />Check ~`, o Chedc # Z~Z ~. Cash ~ ° ~~" ~ Credit $ Billed a . • : Rec dl2 ~?4l3 ~ ' B . . . . <br />Wfiite-DevelopmeM Servioes~ Gree~-F'x~arwe. Yelbw App~icant, Pink-PAC. Goldenrod-Engr. Inspedion , PW:PAC09.FOR 04/28/S <br />