Correspondence CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
OWNER
Plumbing Signature Form
Permit #: MST1999 -00155
Date Issued: 5/4/99
Parcel: 1 S125DA -10300
Site Address: 09435 SW 69TH AVE
Subdivision: PP1994 -032
Block: Lot: 002
Jurisdiction: TIG
Zoning: R-4.5
Remarks: Alteration to an existing dwelling.
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return
this Plumbing Signature Form prior to the start of the work .
No plumbing inspections will be authorized until this completed form is received
AN INK SIGNATURE IS REQUIRED ON THIS FORM
OWNER: PLUMBING CONTRACTOR:
JUSTIN SANDEFUR OWNER
9435 SW 69TH AVE
TIGARD, OR 97223
Phone #: Phone #:
Reg #:
x sa --
Sig of Authorized Plumber
Please return this completed form to the address above.
ATTN: Building Dept.
If you have anv questions, please call (503) 639 -4171, ext. # 310
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
OWNER
Electrical Signature Form
Permit #: MST1999 -00155
Date Issued: 5/4/99
Parcel: 1 S125DA -10300
Site Address: 09435 SW 69TH AVE
Subdivision: PP1994 -032
Block: Lot: 002
Jurisdiction: TIG
Zoning: R-4.5
Remarks: Alteration to an existing dwelling.
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical permit to be valid, the signature of the supervising electrician is required.
Please have the appropriate individual from your company sign below and return this Electrical Signature
Form prior to the start of the work to the address above, ATTN: Building Dept.
No electrical inspections will be authorized until this completed form is received
AN INK SIGNATURE IS REQUIRED ON THIS FORM
OWNER: ELECTRICAL CONTRACTOR:
JUSTIN SANDEFUR OWNER
9435 SW 69TH AVE
TIGARD, OR 97223
Phone #: Phone #:
Reg #:
x 1 S
Sign - re of Supervising Electrician
If you have anv Questions, please call (503) 639 -4171, ext. # 310