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01/10/97 11:52 '$`503"684 7297 CITY OF TIGARD 10006/008
Fire ' otection Permit Application Plan Check # 0 / - ` 75 - c- --
'QTY OF TIGARD '/?\K\ Commercial or Residential Recd Byii./4
3125 SVV HALL BLVD. -14- Cate Recd �/ r- 7 `
Z9
!GARD, OR 97223 Print or Type Date to P.E.
$03) 639 - 4171 Ext. 304 ncomplet or illegible applications will not be accepted Date to DST '�
Ill ‘al Permitit f % - d,3f1,5
fi Called (1
ame of Devei•pment/Pro)ect Type of System (Complete A or B as applicable)
Job %° 411 4 �. ` ' ; � .
A yoe - ' J "'�' A.) Sprinkler Wet Dry ❑
Address / j oUR / �GlrC k7acl standpipes
- lJe/il / Li/ 9Ji Hazard Group
Owner mailing Address _/ Additional /6/
330 //2- / 4o�,= Information Density l
City / tate s Zip Phone "7-61 e Q(
' ./. r ' 1 - 4 Z 1 ' Design Area �/�
Name /a='9
K Factor
Occupant Mailing Address 3, 5
City /State Zip Phone Sprinkler Project Valuation $ / a co
COT Business Tax or Metro # Exp. Date B.) Fire Alarm 6) I .LicH . A '� a I 1 (6,7
Submitt2l Shall Include Battery Calculations YES 0
Contractor N• e /
�.a. .•e1. , / L � ,, �'� , y v Individual Component YES
(Sprinkler or J ('3D it(ng Address _ .., r' Cut Sheets
Alarm f 4m l� Fire Alarm Project Valuation $
Company) Citt /State Zip Phone 3b
t) L Qgdv3 6c/3-6051a-7 ... Project Valuation Subtotal (A or B) g 9
Attach Copy State Cons[. Cont. Board t1e.# p. date -7 b t (Q ' 1 7. . '' - I of 0 101 13 1
5 — � Permit fee based on valuation $
Current COT Business Tax or Metro # Exp. Date —
Licenses (see chart on back) .e u
Name 5% Surcharge 5 . • .
Architect Ma dresA n e tsi r '17 FLS Plan Review 40% of S ubtot i $
' 'TOTAL
't 1d e l y! d � 1- `W 9Q' N J ne 9 , . .
Describe work A.) New Addition 0 Alteration 0 Repair 0 PLANS MUST BE SUBMITTED. approved and a permit issued prior to insoulation.
Three sets or plans ono sae plan (and vlanIry map) regwree inn= shows Ioceoon or
to be done: nearest hydrant.
B.) Basement 0 Hood/Vent 0 Spray Booth O I hereby acknowledge that I have read this appneatron. that the information given is
Complete id. Partial 0 Exitway 0 correct. that I am the owner or authanzed agent of the owner. and mat $ens suomateo
are in comptlantra with Oregon State laws.
Additional Descrtpion of Work: t /NA F ` ' /mil {L 519 . ,•Rot Ow , e t� D ate
Y� — /VIM- /32: ! ,� / -/ - y7
A.) in Existing Building ❑ New Building I- Co Pe 'on Nam = Phone �� a
Building _ /6/ . e � 93 -& Sln"7 -
Data B.) Commercial ❑ Residential FOR OFFICE USE ONLY:
C Plat # Map/TL#
I No. of stories: ; r` l J
Sq. Ft: D 5 ., / -
Notes
Occupancy lass.; ., — 1 Type o Cpr ±9wction
t
losislhresupr.doc
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