Permit Support Document 3 -21 -2000 12:13PM FROM ACI MECHANICAL 503 639 0498 P.1
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CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
RECEIV
.'ORTANT PERMIT NOTICE MAR 2 2 2000
ACI MECHANICAL USA INC BY:
12300 SW 69TH AVE
TIGARD, OR 97223
Plumbing Signature Form
Permit #: MST1999 -00385
Date Issued: 12/13/99
Parcel: 2S103AB -04300
Site Address: 12390 SW 114TH TERR
Subdivision: WALNUT GLEN
Block: Lot 001
Jurisdiction: TIG
Zoning: R-4.5
Remarks: PATH]: New single family dwelling w /attached garage
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 to the address above, ATTN: Building Dept.
t� llurnbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
RIVERSIDE HOMES ACI MECHANICAL USA INC
1 5455 NW GREENBRIER PKWY #140 12300 SW 69TH AVE
BEAVERTON, OR 97006 TIGARD, OR 97223
Phone #: 845 -0986 Phone #: 598.4798
Reg #: LIC 137663
PLM 3'243PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
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Signature of Authorized Plumber
If you have any questions, please call (503) 639 ext. # 310