Permit City of Tigard • COMMUNITY DEVELOPMENT DEPARTMEN'1 V
1111 Is Request for Permit Action JAN 2 9 2020
T ;c-; E t 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 •www.tigati kO f TIGARD
10 I r`ASK-
1 MI
TO: CITY OF TIGARD fl
Building Division W
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner rq<Applicant ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) ?OtAjaa) g ',('j 1 4 t L'L
Mailing Address: '103 ) S 510
City/State/Zip: Vo. '.6Vufe-R. W Pr ckt(,0(00 •
Phone No.: ,0 0' lv`i 5 "
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
71 CANCEL/VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit#: 1115 ZU�D' COO i t 3 x
tt�tt�3�� Y�' ,
Site Address or Parcel#: ttt3vy t}y ,,. C/Ocb em-$T L
rTh
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Project Name: ��JV ,o v
Subdivision Name: p LCte,-� Lot#: /0 Z-/0(p 80 e
EXPLANATION: `4e3 uicI to L C1i 3w i n-CJJ '1�0 `�` v�,� SQ
Signature: Date: 1 12R.` 20
Print Name: pn OrriS
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
k /v /'— 0 T /S S' C6-6
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FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date ft 2z, By,,ey/
Refund Processed: Date /V/ By 24,4, Invoice Processed: Date ni/-20 By
Permit Canceled: Date3 /iJ' B �/ 'arcel Tag Added: Date r By
I:\Building\Fortes\RegPermitAcrion_ 205 8.doc
Mechanical Permit ApplicatirECEI jED FOR OFFICE USE ONLY
City of Tigard ReDate/By:
FOR
e ive Permit No.: Q wtst 20 00'
" 13125 SW Hall Blvd.,Tigard,OR 97223 FEB 2 5 2019 Plan Review
-
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 B Date Read Juris
See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: S plemental Information
BUILDING DIVISION
r
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIALEQUIPMENTISYSTEMSFEES*
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:u 11 r� 1 Air conditioning 46.75
Job site address: I I9 V� �� el D k V . d ira(1 Q / Furnace 100,000 BTU(ducts/vents) l 46.75
City/State/ZIP:Tigard,OR 97224 V `� Y V`-� Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Polygon at Roshak Ridge Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above , 23.32
Subdivision:Polygon at Roshak Ridge Lot no.: (D Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 1 33.39
Flue vent for water heater or gas
fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
PROPERTY OWNER 0 TENANT Environmental exhaust and ventilation:
Name:Polygon WLH LLC Range hood/other kitchen
equipment I 33.39
Address:703 Broadway St.Ste 510 Clothes dryer exhaust I 33.39
City/State/ZIP:Vancouver WA 9860 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 9 23.32
Phone:(360)695-7700 Fax:(360)6934442 Attic/crawlspace fans 23.32
El APPLICANT 0 CONTACT PERSON Other: 23.32
Business name:Polygon WLH LLC Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Amanda Gavin Furnace,etc.
Address:703 Broadway St.Ste 510 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Vancouver WA 98660 Water heater
Phone:(360)695-7700 Fax: :(360)693-4442 Fireplace
Range
E-mail:permitsubmittals@polygonhomes.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:TBD Other:
MECHANICAL PERMIT FEES*
Address:
Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lic.: TOTAL PERMIT FEE
— This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signa e: * Fee methodology set by Tri-County Building Industry Service Board
Print name:Amanda G m Date: W ��
I\Building\Permits\MEC_PermittApp_040113.doc -4617T(1 /0^ WEB)
Electrical Permit Application RECEIVE IFOR OFFICE USE ONLY
City of Tigard FEB 2 5 2019 Received MST ST2^2^r h qn 13
- Date/By: Permit#: Pry j/(L Cj(�(�
IIIe 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 CITY OF TIGARD Date/By: Related Permit#:
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION Ready Date/By. Juris lZ See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
0 Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION p ❑Emergency system. larger separately derived
Job#: Job site address: I .1 I C /� I f 0(/t r I1rtS ❑Addition of new motor load of system.
U 1 �/ l 1 (/S �/1/V 100 or more. ❑system.
City/State/ZIP:Tigard,OR 97224 1/l' n ❑Six orHealth-care f more residential units. occupancy.
U I7 (IL ❑ ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Polygon at Roshak Ridge ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description 1 Qtv. I Each I Total 1
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at Roshak Ridge Lot#: 022 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'I 500 sq.ft.or portion 1 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
® PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name:Polygon WLH LLC 200 amps or less 100.70 2
Address:703 Broadway St.Ste 510 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Vancouver WA 98660 601 amps to 1,000 amps 301.04 2
Phone:(360)695-7700 Fax:(360)693-4442 Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
�® APPLICANT ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Polygon WLH LLC above service or feeder fee, 7 42 2
each branch circuit
Contact name:Amanda Gavin B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address:703 Broadway St.Ste 510 branch circuit
City/State/ZIP:Vancouver WA 98660 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360)695-7700 Fax: :(630)693-4442 Each manufactured or modular 67.84 2
Email:permitsubmittals@polygonhomes.com dwelling,service and/or feeder
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:TBD Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(I hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(/hr min)
ELECTRICAL PERMIT FEES '
Suprv.Electrician signature,required: Subtotal:
Print name: Date: 0 Plan Review Required(25%of permit fee):
4111.' State surcharge(12%of permit fee):
Authorized signa , TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Amanda G-,in Dater .- -/p days after it has been accepted as complete.
/// ��` * Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev06/17/2015 440-4615T(11/05/COM/WEB
Plumbing Permit Application
Building Fixtures RECEIVE , FOR OFFICE USE ONLY
City of Tigard Received
Date/By:
- g FEB 2 5 2019 Permit No.:MST2O20-00015
illq 13125 SW Hall Blvd.,Tigard,OR 97223
6� Plan Review
Phone: 503.718.2439 Fax: 503.598.19t,ITY OF TIGARD Date/By: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 Date Read B orris: H See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method. Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition For special information use checklist
Description Qty. 1 Ea. 1 Total
0 Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath l 500.32
0 Accessory 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 111 0q Cl O\K. Uu(At-Icon-au. / Catch basin or area drain 18.76
�' Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name:Polygon at Roshak Ridge Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision:Polygon at Roshak Ridge Lot no.: I
U� Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name:Polygon WLH LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:703 Broadway St.Ste 510
Garbage disposal 25.02
City/State/ZIP:Vancouver WA 98660 Hose bib 25.02
Phone:(360)695-7700 Fax:(360)693-4442 Ice maker 12.51
ra APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name:Polygon WLH LLC
Primer 12.51
Contact name:Amanda Gavin
Roof drain(commercial) 12.51
Address:703 Broadway St.Ste 510 Sink/basin/lavatory 25.02
City/State/ZIP:Vancouver WA 98660 Solar units(potable water) 62.54
Phone:(360)695-7700 Fax: :(360)693-4442 Tub/shower/shower pan 12.51
E-mail:permitsubmittals@polygonhomes.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:TBD Water P�P� �1 m WV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.:
State surcharge(12%of permit fee)
Authorized signatur TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180 days
Print name:Amanda Gavi Date:49?-/-71
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
III COMMUNITY DEVELOPMENT DEPARTMENT
■
T 1 G A R ll Building Permit Review — Residential
Building Permit #: MSTZo2D-0o013
Site Address: 113 09 0/0 q/I co 3 L ---7,-fi,,oce
Project Name: Pdoi_e h 642k ,6� Lot #: 05
(New. ar; g=subdivision name;Addition or Alteration- t name of owner)
Planning Review
Pro�sal: / ) VP/9-
V Verify address/suite#active in Accela. 2J In River Terrace: 0 No IEKes, River Terrace Review Addendum
Sit Plan Elements: Erosion Control
013 •spies of site plan on 8-1/2"x 11"or 11 x 17"paper Li tained trees with drip line and tree protection measures
To 1 .wn to scale(standard architect or engineer scale) ,�,/F6otprint of new structure(including decks)and FFE
Ed' .rth arrow ri ty locations&easements(required for new and additions)
n S' address,project or subdivision name and lot number MJ/Sidewalk/driveway approach
( plicant information(name and phone number) 11 .-,lion of wells/septic systems
Lot dimensions and building setback dimensions 1+% et ttee size;type tad location =
tit;quare footage of buildings to be demolished I S eet names
11, .sting structures on site riComer elevations(2'contours if more than 4'diffe/ntial)
Y .t area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replac ? YYes ❑I
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? Yes L✓1No
`Clean Water Services—Service Provider Lett (lot platted prior to 9/10/1995):
equired: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No
VJ Public Faciliiti�mprovement(PH)Permit:
R uired: ® Yes,applicant was notified ❑ No Applied For: Yes ❑ o,stop intake
Ov and Use Case#: �t C'i 6/Oj, ?/ g: — .2
quired Setbacks: Front: /Q Rear: Side: Street Side: • Garage: / . c—
Vilding Height: Max. Height: Actual Hei ht: S
andscape Area: c-.2 0 % Lot Coverage Max: O cyo
Entrance t back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 d or less
Windows ❑ Minim 2%of area of all street-facing facades
Garage ❑ Garage door is ' d widest street-facing wall ,3\K- ❑ Yes o,one of the following is met:
❑ Door extends no m an 5'from wall and there is a ed porch extending beyond garage.
❑ Door extends no more than m wall a re is a 12 sq ft.window above garage on 2nd floor.
❑ Garage door width is ❑ 12'or les ° or less of facade ❑ 60%or less and includes 7 of following:
❑ Covered porch cessed entrance offset ❑ 1'Roof eave ❑ Roof offset
❑ Fire s ' ❑ Lap Siding ❑ Roof pitch hi ,or gambrel roof ❑ Dormer
ccent siding Window trim ❑ Window recess ow projection ❑ Balcony
�1�Visual Clearance Urban Forestry ' t.`
ill sensitive Lands: 0 Yes X, No Type:
❑ ConditionsAet ptior to issuance of building permit
No s: ( 64rathl.4 J ,S r11 Tar- -741) iti/9- / C/ 6c
Approved By Planning: Date: 1 Z,Zd fl
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: 0 Approved 0 Not Approved
i:\Building\Forms\BldgPernutRvw_RES_022819.docx
Building Permit Submittal Original Submittal Date: 06/20 p
Site Plans: # 3
Building Plans: # 2
Building Permit#: a Enter building permit#above.
Workflow Routing: ai- Planning C-Engineering [ Permit Coordinator Er Building
Workflow Sign-off: [f-Sign-off for Planning(include notes from planning review)
Route Application Documents: [I'Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
C`3"Building. original permit application,site plans,building plans,engineer and
beam calculations trust details,if applicable,etc.
Notes:
By Permit Technician: Date: D/-D4-2O2.0
Engineering Review
PrConditions lope at building pad: 3
"Met"prior to issuance of building permit ,!/'f
Pt , asements (encroachments)per engineering conditions of approval and plat
l.' Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes IL/No
Assess Water Quantity Fee in-lieu: 0 Yes o
LIDA Facility on lot: ❑ Yes tin No
IA/Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
ot
LJ Approved by Engineering: Date: // /24'
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
R Sion Notice 3: Date Sent to Applicant:
SDC Fees Entered: Wash Co Trans Dev Tax: IYes ❑ N/A
Tigard Trans SDC: [eyes� ❑ N/A
Parks SDC: tGl Yes ❑ /A
LIDA ❑ Yes /A
OK to Issue Permit
f 7?-/7/(2Approved by Permit Coordinator: Date:
I:\Building\Forms\BldgPernutRvw_RES_0228I9.docx
City of Tigard
11111 v COMMUNITY DEVELOPMENT DEPARTMENT
T 1 c A R D River Terrace Building Permit Review Addendum
Building Permit #: kitc3 ZQ2. 00013
Site Address: 1"'10`( ' `(') gea('7,,,,z �i,,e
Project Name: Pd , ;0 :�.,L � �� Lot #: l p
(New: rng=subdivision name;Addition or Alteration t...4. t name of owner)
Planning Review of River Terrace Plan District Design Standards (18.640.070.1):
Is the project subject to the plan district design standards? ❑ Yes ❑ No
1.Articulation: a minimum of 1 element per each street-facing facade that has 30-60 ft. of frontage.An additional
element required for lots with over 60 ft. of street frontage shall be provided every 30 ft.
Porch min. 5 ft. deepBalcony w/ access 2 Window Projection Vertical Wall Offset a
❑ ft. de • min. 2ft., 5 t.wide min. 2 ft., 6ft 'de Gabled dormer
' ie- 007—t RkE-
2. Eyes on the street: a minimum of 12%of each street facing fa ade um adows or entrance doors.
F
Percentage Shown: /�t/ e' >�2 �/ t ..,-,,, v-m y 1 1 e7r�t -[ 7
trances:At least one entrance must meet both of the follo ' g standards: �L IZ Z'I1
Max. 8 ft. setback from longest street- ing wall Parallel to street,angle no more than 45° from street,
or open onto porch
Entrance opens to a porch: ❑ Yes No
If yes,all the following apply: ❑ 25 sq.ft.min.
❑ One street facing entry 0 12 ft.max. roof above floor of porch
❑ 5 ft. depth min. ❑ 30%min.porch roof coverage
4.Detailed Design:All buildings shall include a min. of five of the following elements on all street-facing facades:
• overed porch min. 5 ft.wide x 5 ft. deep 0 Recessed entry area min. 5 ft.wide x 2 ft. deep
Wall offset min. 16 inches 0- c ❑ ormer min. 4 ft.wide
Roof eave min. 12 inch projection's+ oof offset min. of 2 f---erC c
❑ Roof shingles either tile or wood 1y,able,hip or gambrel roof design f'
❑ oof pitch oriented south min. 500 sq. ft. I $orizontal lap siding min. 3-7 inches wide
Oa Accent siding min.40%of street facade`/ IQ Window trim min. 2 '/z"wide by 5/8"deep i k
❑ Window recess min. 3 inches for all street facing ❑ Bay window min. 5 ft.wide by 2 ft. deep
❑ Balcony min. 5 ft.wide x 3 ft. deep with inside access ❑ Attached garage is 35%or less of street facade
5. Garages and Carports:May face the front or side lot line on a corner lot.
Setbacks: '
No closer to front or side lot line,than longest street-facing wall. ❑ Yes [2 No. If No (Check one):
ir
❑ Iay extend up to 5 ft.if there is a covered front porch and garage does not extend beyond the front porch.
May extend up to 5 ft.where the garage is part of a two-story building and there is a window at the second story
above the garage that faces the street with a min. area of 12 sq.ft.
Wkh: (Check one)
12-foot-wide garage door ❑ 40%max. of street façade
❑ 50%max. of street facade with 7 detailed design elements
Notes:
Approved By Planning: lik,,k_ Date: I 2,'1-1 1
1.\B \ \B uildingFormsldgPe muRvw_RES_RT_121417.docx
1