Permit LZ• �
CITY TIGARD SEWER CONNECTION PERMIT
I� DEVELOPMENT SERVICES DATE PERMIT #: 9/29/03 : WR2 03 -00364
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 13535 SW 72ND AVE 145 PARCEL: 2S101 DC -00200
SUBDIVISION: 72ND AVE OFFICE BUILDING ZONING: C - P
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: SPEC SPACE
USA NO: FIXTURE UNITS: 2
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: .1 EDU increase. Previous EDU =9.3 =148.8 fixture values. Addition of 2 fixture values, for a new
total of 150.8 fixture values =9.4 current EDU's.
Owner:
FEES
PACIFIC NW PROPERTIES LTD PTNSHP
9665 SW ALLEN BLVD STE 115 Description Date Amount
BEAVERTON, OR 97005 [SWUSA] Swr Connect 9/29/03 $240.00
[SWUSA] Swr Connect 9/29/03 $0.00
Phone:
Total $240.00
Contractor:
Phone:
Reg #:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180
days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee
the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect
3 feet in all directions from the distance given. If not so located, the installer shall purchase a "Tap and Side Sewer" Perm
Issu by: k / = - Permittee Signature: j (,(JO(f,u RAIR4
CaII (503) 9-4175 by 7:00 P.M. for an inspection needed the next business day