Permit CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit #: SWR2010 -00120
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/07/2010
Parcel: 1 S 133 DA05200
Jurisdiction: Tigard
Site address: 12760 SW GLACIER LILY CIR
Subdivision: amart Lot: 74
Project: Liebreich
Project Description: Sewer connection for new SF.
FEES
Owner:
LIEBREICH Description Date Amount
12760 SW GLACIER LILY CIR Sewer Connection Fee 10/07/2010 $4,100.00
TIGARD, OR 97223 Sewer Inspection - Residential 10/07/2010 $35.00
PHONE:
Contractor:
PHONE:
FAX:
Type of Use: SF
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $4,135.00
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work wit be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, o • is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by t e Oregon
Utility • ification Ce - r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a c• • of the rules
or dir= question to OU C by c. a 503.246.6699 or 1.800.332.2344.
Is ed By: 114j1/■ L _r Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.