Permit Support Document P _CEivED
CITY OF TIGARD
13125 S.W. HALL BLVD. ""
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE qayoi
EVANS ELECTRIC INC
10150 SW NIMBUS AVE E -6
TIGARD, OR 97223
• Electrical Signature Form
Permit #: MST2000 -00344
Date Issued: 5/16/01
Parcel: 2S105DA- HCE185
Site Address: 14913 SW 1 E- FALKLf}ND Cr
Subdivision: HILLSHIRE CREEK ESTATES NO. 4
Block: Lot: 185
Jurisdiction: URB
Zoning: R -7
Remarks: SFD - Plan 2444 - Master Plan Review - Setbacks as per approved site plan
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
OWNER: ELECTRICAL CONTRACTOR:
K & F HOMES LLC EVANS ELECTRIC INC
P.O. BOX 7309 10150 SW NIMBUS AVE E -6
BEAVERTON, OR 97007 TIGARD, OR 97223
Phone #: 503 - 848 -3899 Phone #: 639 -5572
Reg #: LIC 142204896 5S
SUP
ELE 34 -405C
AN INK SIGNATURE IS REQUIRED ON THIS FORM
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Signat of ' •ervising Electrician
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If you have any questions, please call (503) 639 -4171, ext. # 310