Permit CITY OF TIGARD SEWER CONNECTION PERMIT
I 12. COMMUNITY DEVELOPMENT Permit #: SWR2009 -00048
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/26/2009
�°`" Parcel: 1 S 136 DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HVVY
Subdivision: Lot: 0
Project: Fred Meyer
Project Description: .1 EDU increase.
FEES
Owner:
FRED MEYER STORES, INC Description Date Amount
BY NICKEL & COMPANY LLC, STORE #375, PO Sewer Connection Fee 06/26/2009 $310.00
BOX 35547
PHONE:
Contractor:
PMSI LLC
21195 NW EVERGREEN PKWY #204
HILLSBORO, OR 97124
PHONE: 503 - 466 -2222
FAX: 503 -466 -2211
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .1
Total $310.00
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 will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0100. You ma • : copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: i t '/ - Permittee Signature: f - U� J.
Call 503.639.4175 by 7:00 a.m. for an inspection that busines
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.