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10/97 11:52 $503 884 7297 CITY OF TIGARD 0006/008
i - Protection Permit Application Plan Check # ( - G8 c
;TY TIGARD 1 ) \ Commercial or Residential Recd By/r\--)
3125 SW HALL BLVD. Date Recd f
IGARD, OR 97223 Print or Type Date to P.E. 1- � -9 /
503) 639 -4171 Ext 304 Incom • ete or illegible applications will not be accepted Date to DST y 3 - 97
Permit 8 13U.P% 0,
/5'/„ / Called 1- 7- q7
are of Devel pment/Project Type of System (Complete A or B as applicable)
Job 1 4 S �, ` - Ft -1; Sprinkler Wet rY E, Address Add ss Q A.) P x D
' / A. i R. /1 /4 . • Standpipes
Ma i Li/ t // Additional hazard Group F C /
Owner 30 lri �1 61
�° � / Information Density cmry Pr�l1� C�}' ��4 - 451 - gz� e ar/
l
/ i ( Design Area .4 —
Name ��r�
K. Factor
Occupant Mailing Address 5,5
Cit Zip Phone Sprinkler Project Valuation $ 9 9so .00
COT Business Tax or Metro # Exp. Date B. Fire Alarm '0a 2j10
Submittal Shall Include Battery Calculations YES 0
I Contractor e � fizor Ki IN° M .lf_ 1( Individual Component YES (]
(Sprinkler or arching Address I ,nn�, Cut Sheets
Mann , i) 3C i ''ti V�4rtlr/ 4}
� lailA • .,--
Company) Ci /State Zip Phone 3 ,o Fire Alarm Project Valuation $ 1 -
U t 0 1 `1 6 -(0 5/07 --
Attach Copy State Const. Cont. Board Lic.# Exp. Date Project Valuation Subtotal (A or B) g 9q .' 0 • 0 I A
of 0/pgL3 Permit fee based on valuation ! ``°
Current COT Business Tax or Metro ti Exp. Date 5 , • () (p
(see chart on back) 171 Licenses
5% Surcharge $ _ t,
Name leA56 _1 / ( ' � , �� FLS Plan Review 40% of Subtotalf $ 2 e ik
Architect
Mailing ito �t1A ^ / � TOTAL � �
City /State Phone - r...40 (c7
llllle & reel ' d l- 4 4-
PWVS MUST BE SUBMITrEO. 8O0fClved and a Permit issued Fna to insvuaoon.
Des work A.) New Addition 0 Alteration 0 Repair 0 Three sets of plans and site plan (aria vicinity map) reawrea which shows ;wham or
to be done: nearest hydrant.
, B.) Basement 0 Hoot:/Vent 0 Spray Booth 0 t hereby amytnewtedge that I have read this appricabon, that the inform:mon given is
Complete 4 Partial 0 Exirway 0 comet Viet I am the owner or authorized age ht of the owner. and mat pis suarnineo
are in compIlent2 with Oregon State laws
, odition al D escnption of work: 0 /. `(I '5 i2Nt�l{i
P S ig . re of • an . ent Date
s W --- / /32 ��,, l / -7 —9
A.) In Existing Building ❑ New Budding Contact Pa 'on Nam Phone -- '& 7 ,a
Building 61/ a /j
le 93
Data B.) Commercial ❑ . Residential FOR OFFICE USE ONLY:
Plat # MapR1f
No of Stories 51
. tS : ..
5a. Ft: ; / _ Notes
Occupancy Iasi.; lQ Type o .Construction • •
•
ma stslfiresupr.doc C
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