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Permit
SEWER CONNECT ION C� CITY OF TIGARD PERMIT #f- 'f.RMTT 5WFt95 "E+ COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 116 / 26 / 9 5 13125 SW Hall Blvd. Tigard, Oregon , 97223.8199 ' (503) 639 -4171 PARCEL: 1 S 1260C -1211 107 SITE ADDRESS...: 09627 SW WASHINGTON SQUARE RD SUBDIVISION.. e .: ZONING: C -G BLOCK;.., ........ . LOT. . .. ... TENANT NAME— ..., :RAINIER ROASTER USA NO FIXTURE UNITS. .. :31 CLASS OF WORK. .. :ALT • DWELLING UNITS. . :2 TYPE OF USE °CON NO. OF BUILDINGS: INSTALL TYPE ' -BUSWR IMPERV SURFACE..: :sf Remarks: TI for restaurant Owner: - - -- - - -- FEES ----- WESTERN ROASTERS INC. type amount by date recpt PRMT $ 4400.00 SW 106/26/95 - 1680 WILLAMETTE FALLS DR WEST LINN OR 97068 Phone #: Contractor: - - - - -- _- - • CONTRACTOR NOT ON FILE • Phone #: $ 44k'10.00 TOTAL. Reg --- -• - -•- REQUIRED INSPECTIONS - •- --- °- - - -- This Applicant agrees to conply with all the rules and regulations Sewer Inspection of the Unified Sewage Agency. The peroit expires 180 days frog the date issued. The total aoount 'paid will be forfeited if the _ per ©it expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the oeasureoent given, the installer shall prospect 3 feet in all' directions frog the distance given. If not so located, the insta •r shall purchase a °Tap and Side Sewer° Peroit and the "cy wi insta 1 a lateral. • Permittee Signature: liwAi' - Issued By • Call for inspection - 639 -4175 • • • Commercial Building Permit Application City of Tigard 13125 SW Hall Blvd. cro Tigard, OR 97223 gC 1 f i (2� Y" 9C (503) 639 -4171 Jobsite Add ss: ,,. Y ,,, :,. : ,,,, •J.• �l Onf{� �.. \. .,� \`.��'.:.`�`; tit �l Tenant: ^' G/ 0 5 Officcss E1§e�.x <,:',: , „ , : : :' :— . \ 4 e ` Suite # E.. }.<.; ...� : ` »' 1 Pland Rec.. • .t r. .. .. .. ? ; ::ti � :., ; :': .:1.;: Valuation: �^ , : Owner: V v � ••��>'� • .. Address: ' : . . ; . . }... }::'•l'R . \..•` :. } r. • - ' :: • ..:•� :'.•; :• :: ' `:Abpirovas�eau1 _': >•:.: «'. :::� : . . �' •� . :.; : ; :i :: . : : . % . :: < > . ; ;. ^ • t ; \ ?} �• .E.: 4i yr } Phone: :31;: . : : :: : :: '. ? \•• 'Ot ` .... Contractor. 1,' h b\ �},'�'✓� tjtLtA.,u")1 Address: Type of const: Occupancy class: Phone: Sprinklered? Yes No Contractors 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: ��°'�`'�f C Ear CZ, ` � Q SL L c2/__Ii 9c -00 7 77 / Applicant Signature & Phone number Received by: Date Received: Permit # Account Description Amount Amt. Pd. Bal. Due Bldg. Permit (BUILD) Plumb. Permit (PLUMB) Mech. Permit (MECH) State Tax (TAX) Bldg:. Plumb: Mech: Plan Check (PLANCK) Bldg: Plumb: Mech: Sewer Connection (SWUSA) Sewer Inspection (SWINSP) Parks Dev Charge (PKSDC) Residential TIF (TIF -R) Mass Transit TIF (TIF -MT) Commercial TIF (TIF -C) Industrial TIF (TIF -I) Institutional TIF (TIF -IS) Office TIF (TIF -0) Water Quality (WQUAL) Water Quantity (WQUANT) Fire Life Safety (FLS) Erosion Cntrl Permit (ERPRMT) Erosion Planck/USA (ERPLAN) Erosion Planck/COT (EROSN) ve TOTALS: 1- 'a° l/f/ge-