Permit E WER CONNECTION
CITY OF TIGARD PERMSIT #PERMTT SWR95- -02.31
COMMUNITY DEVELOPMENT DEVAIVIIMENT DATE ISSUED: 08/30/95
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4.171
PARCEL: 1S1260C -01107
SITE ADDRESS— °: 09651 SW WASHINGTON SQUARE RD
SUBDIVISION ZONING: C —G
BLOCK • LOT
TENANT NAME •MACHEEZMO MOUSE
USA NO FIXTURE UNITS... :27
CLASS OF WORK. :ALT DWELLING UNITS.. :2
TYPE OF USE °COM NO. OF BUILDINGS:
INSTALL TYPE •BUSWR IMPERV SURFACE..: :s
Remarks: TI for restaurant — Sewer fees for plumbing fixtures added
Owner : -- FEES
MACHEEZMO MOUSE RESTAURANT type amount by date recpt
1020 SW TAYLOR SUITE 585 PRMT $ 4400.00 JDA 08/29/95 95 -269908
PORTLAND OR 97210
Phone #: 274 -0001
Contractor: —
CONTRACTOR NOT ON FILE
Phone #: $ 4400.00 TOTAL
Reg L. °
REQUIRED INSPECTIONS
This Applicant agrees to coapiy with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The permit expires 180 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 Agency �will install a�
/
Permittee Signature: " I/
Issued By:
Call for inspection — 639 -4175
Commercial Buildin ,Permit Application
City of Tigard o 7 `A
13125 SW Hall Blvd. _ e-,eK
Tigard, OR 97223 p !`
(503) 639 -4171 -
Jobsite Address: 96c-;7 v " 4c1 ��
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Tenant.
l`/( /44° S uite #
.:: PlancWRec' #: •• " ::' ::;: ..
Valuation: :: • •• •
:...: '` :
G Owner:
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Address:
Aaarovals Reaui'ecf::: }: " < ...;`.:'.:.: ;:; .
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o e:
Other
Contractor ..................
....... .....
•
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)
/ �
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
• State Tax (TAX)
Bldg:
Plumb:
Mech:
Plan Check (PLANCK)
Bldg:
Plumb:
Mech:
G gS.o G ov 174vra
ewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF -R)
Mass Transit TIF (TIF -MT)
Commercial TIF (TIF -C)
Industrial T1F
Institutional TIF (TIF -IS)
Office T1F (TIF -0)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntri Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS: