Correspondence 08/07%01 TUE 16:24 FAX 503 598 1960 CITY OF TIGARD
0003
CITY OF TIGARD
13125 S.W. HALL BLVD. Q,?
, X
. 4 , TIGARD, OR 97223
xIFRTANT PERMIT NOTICE
qA
MODERN PLUMBING
11120 SW INDUSTRIAL WAY
TUALATIN, OR 97062
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Plumbing Signature Form
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Permit #: PLM2001 -00151
'Date issued: 7/30/01
Parcel: 2 S 114A0 -01500
Site Address: 17005 SW 92ND AVENUE
Subdivision:
Block: Lot:
Jurisdiction: TIG
Zoning: R -12
Remarks: Site utilities associated with Cook Park expansion.
Your company has been indicated as the pl imbing contractor for the permit indicated above. In order for the
.)iumb ing permit to be valid, please have till: 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
OWNER: PLUMBING COW RAG I OR:
TIGARD, CITY OF MODERN PLUMBING
13125 SW HALL 11120 SW INDUSTRIAL WAY
TIGARD, OR 97223 TUALATIN, OR 97062
Phone #: Phone #: 691 -6166
Reg #: LIC 87906
PLM 34 -250PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signature e` Authorized Plumber
;;:_a,fe an'! Questions, please call (503) 639 -4171, ext. # 310