Permit CITY OF TIGARD
DEVELOPMENT SERVICES PLUMBING PERMIT
1 L 13125 SW Hall Blvd., Tigard, OR 97223 (503)639 -4171 PERMIT # • PLM96 -0320
DATE ISSUED: 10/22/96
PARCEL: 2S104CD- 10300
SITE ADDRESS...: 13633 SW TRACY PL
SUBDIVISION • HILLSHIRE ESTATES NO. 2 ZONING: R -7 PD
BLOCK • LOT •102
CLASS OF WORK..:NEW GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE -SF WASHING MACH • 0 BACKFLOW PREVNTRS..: 1
OCCUPANCY GRP..:A1 FLOOR DRAINS : 0 TRAPS • 0
STORIES • 0 WATER HEATERS • 0 CATCH BASINS • 0
FIXTURES LAUNDRY TRAYS 0 SF RAIN DRAINS 0
SINKS • 0 URINALS • 0 GREASE TRAPS : 0
LAVATORIES • 0 OTHER FIXTURES • 0
TUB /SHOWERS • 0 SEWER LINE (ft)...: 0
WATER CLOSETS..: 0 WATER LINE (ft)...: 0
DISHWASHERS • 0 RAIN DRAIN (ft)...: 0
Remarks: ADDING BACKFLOW DEVICE
Owner: FEES
WINDWOOD HOMES type amount by date recpt
13633 SW TRACY PL PRMT $ 15.00 10/22/96
5PCT $ 0.75 TAT 10/22/96
TIGARD OR 97223
Phone #:
Contract or:
CEDAR LANDSCAPE
14375 SW PATRICIA AVE
HILLSBORO OR 97123
Phone #: 503- 628 -3411 $ 15.75 TOTAL
Reg #.. : 5843
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Water Line Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other RP /Backflow Prey
applicable laws. All work will be done in accordance with Final Inspection
approved plans. This permit will expire if work is not started
within 180 days of issuance, or if work is suspended for more
than 180 days.
Permittee Signat , �c --
re:
Issued By:
all for inspection — 639 -4175