Permit SEWER CONNECTION
lY
CiTi OF TIG4RD i_E,RMI
r PERMIT # SWR95- 0353
DATE ISSUED: 03,'25/95
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171
PARCEL: 1S136DB -00500
SITE ADDRESS...: 1 1 : , 1 : SW PFC I F I C HWY
SUBDIVISION • ZONING: C —G
I3LC CK • LOT •
TENANT i;AME •MAZATLAN RESTAURANT
USA NO • FIXTURE UNITS... :34
CLASS OF WORK... :ADD DWELLING UNITS. . :2
TYPE OF USE •COM NO. OF BUILDINGS:
INSTALL TYPE •BUSWR IMFERV SURFf- ;CE... : :sf
Remarks: Addition to existing restaurant.
FEES _________
GALVAN CUITRAN PARTNERSHIP type amount by date recpt
114919 SW PACIFIC HWY PRNT $ 4400.00 3G 06/25/35 —
TIGARD OR 97223
Ph en e :It: 228 -3413
Contractor: --
CONTRACTOR NOT ON FILE
Phone #: $ 4400.00 TOTAL
Reg #.. .
REQUIRED INSPECTIONS - - --- --° - --
This Applicant agrees to comply with all the rules and regulations
of the 'Unified Sewage Agency. The permit expires 163 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" permit and the A ency will install a lateral. — _
err; i'cbee Si gnat ure: — -
Issued By: - -- , .....
• Call for inspection — 639 -4175
1 , • Commercial Building Permit Application
• • City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639 -4171
Jobsite Address: I 16 I I SAO Pet
.�� Vti {.{;Mtiv'�.4v.. �'� \'�v'v.� :•::..... 1 . , ^ ,fi r: {'.. ... . .
tiiN'� > } .i {.�. \ \ \:Y.. { ...:;tip . ? r:;t�.:v }`•{4p`{Vi w'r'r.:iii ?:� ?..rhf. Ay ` 5: •:
Tenant Suite #
v� OtRCe} E1ae` Onl1r` � ; ti ;vx \xa •., � � •: x:
Valuation: �andc/Re�
f
?Permit' } ; >.:
Owner el Zq l
Address:
::<A rovals�Re •`
tan `i'
nn
................
ti.: �i:\ tiv' f: i::: ?: \t ?:�nOii ?':•':; '::.:i : Vi::.: }}. .: .X'} }:•:Hitt
Phone: .. .�: <� v :,� :;<�::::::��<::F::::•�:><:.:..
• th
ii: \v:d, n•.. xv }:.i ? ::{ :. <:i } ; v v }};f{ } ' • �i::-nX; {: iii:`:{; : : /: };:v;i: ::i:::L4ii: :?
Contractor Kkit44-t1( : • ::' ?::.::? • , 'sz;.:.: . :.:..: z ::..........,
Address:
Type of const
Occupancy class:
Phone:
Sprinklered? Yes No
Contractor's License #
(attach copy of current Oregon license) Sq. ft. of project
Contact name & phone: Story (1st, 2nd, etc.)
Proposed use:
Architect/Engineer:
Previous use:
Address:
Note: Plumbing & mechanical plans
must be submitted at time of
building permit application.
Phone:
JOB DESCRIPTION:
Applicant Signature & Phone number
Received by: Date Received:
Permit Account Description Amount Amt. Pd. Bal. Due
Bldg. Permit (BUILD) c
Plumb. Permit (PLUMB)
Meets. Permit (MECH)
State Tax (TAX)
Bldg:
Plumb:
Mech:
Plan Check (PLANCK)
Bldg:
Plumb:
Mech:
V `'0
-S5✓ Sewer Connection (SWUSA) 4.0,6 . 0 d
0)&4.12 Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF -R)
Mass Transit TIF (TIP-MT)
Commercial TIP (TIF -C)
Industrial TIF (TIF -I)
Institutional TIP (TIF -IS)
Office TIP (T1F -0)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntri Permit (ERPRMT)
Erosion Ptancic/USA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS: 411)0
" 4
6/16/99 Activities for Case #: SWR95 -00353
2:06:47 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
SWRA007 Application received 8/21/95 JDA PASS JDA 8/21/95
SWRA070 Ready to issue 8/21/95 JDA PASS JDA 8/21/95
SWRA080 (F) Issue permit 8/25/95 JLG PASS JG 8/25/95
SWRA705 Sewer Inspection 9/11/95 • GS N/R GES 9/12/95
SWRA720 Case Finaled 9/22/95 JDA FINL JDA 9/22/95
•
•
• Page 1 of 1