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PLNCK/RECT a � ��3� CITY OF TIGAIRD PERMIT It rn3111 -0Lig4 COMMUNITY DEVELOPMENT DEPARTMENT 11Pr •(3rcgon9zv3 (5O3) 39 -4171 DATE ISSUED JOB ADDRESS: c1 F 37 5 G-3, ri v. ...1 Dv. TAX MAP /LOT 2251 1 I C I) -062o0 SUB: (CA -w.4 rs . LOT: 2 -' 5 " LAND USE: VALUATION: /9 6 OWNER SPECIAL NOTES NAME: Dt(ve.1 4' ka,.,, 1,41 c?a dt.,,, REISSUE OF: ADDRESS: `1x36- Ste. ICr,,br,t. A,, LAST REISSUE: 1 a ,--i Ov, . X17 zz¢ FLOOD PLAIN/ PHONE: SENSITIVE LAND: CONTRACTOR APPROVALS REQUIRED f( NAME: W ei Lo r,4 u� ri" c. PLANNING: .� ADDRESS: ) 4-7 75 5-. 1-' Su,. jrf (3/1 .,1 ENGINEERING: 9 e a,. 47/¢a FIRE DEPT: PHONE: 2-1 88 OTHER: CONTR. BOARD #: 621 ¢/ EX D : 6 ,- Z - - 79 . 9 ITEMS REQUIRED SUBCONTRACTORS: P Ut -. (kr r,I MO I ' Co tl' iu L., bi, , J LIST/SUBCONTRACTORS: MECH: • BUS TAX: - ARCH /ENGINEER CALCULATIONS: NAME: TRUSS DETAILS: ADDRESS: OTHER: PHONE: PROPOSED BLDG. USE: a�� COMMENTS: G %�G� ( 4 / — 3 3( I Z. yZ fZ .40 "___aI s /t% am/ . APPLICANT SIGNATUR�EE Received By: 71:._ Date Received : ( — f r l . PERMIT // ACCT # DESCRIPTION , AMOUNT ,AMOUNT PD. BAL. DUE h/503- 10 -432 00 Building Permit Fees P/0-5 / 10 -431 00 Plumbing Permit Fees 37.re 37.)7) 10 -431 01 Mechanical Permit Fees o 2.�o .15.0u 10 -230 01 State Building Tax (5 %) /DIG / /04lo Building ?: 11 Plumbing 1.S / Mechanical /. z 5 , V 10 -433 00 Plans Check Fee q/33 qi Building 9/ - Plumbing Mechanical 10 -230 06 Fire 30 -202 00 Sewer Connection 30 -444 00 Sewer Inspection 25- 448 -02 Commercial TIF Fees 25- 448 -04 Industrial TIF Fees • 25- 448 -06 Institutional TIF Fees 25- 448 -03 Office TIF Fees 25- 448 -01 Residential Traffic Fees 25- 448 -05 Mass Transit TIF Fees 52 -449 00 Parks System Dev Charge (PDC) 31 -450 00 Storm Drainage Syst Dev Chrg (SSOC) 24- 445 -01 Water Quality (Fee in lieu of) 24- 445 -02 Water Quantity (Fee in lieu of) TOTAL 30£/.4?' 0 £ f / q ' q/ c2/3./6 nm/3587P.WPF •