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01/10/97 11:52 $51'' ::4 7297 CITY OF TIGARD 4006/008
. i IFi r , ' Protection Permit Application Plan Check IS i - q - I �-
•;T� OF TIGARD i i K Commercial or Residential Rec'd By e
3125 SW HALL BLVD. Date Reed Li 1 - 2- 2 - -` f l
IGARD, OR 97223 Print or Type 1E5 Date to P.E. /- - 7
iO3) 639 -4171 Ext. 304 nc • • pieta or illegible applications will not be accepted Date to DST - 3 — "' 7
Permit i
Egang ) 5/
I 5 2:7 0 Called - - '
ame of Devel pm ent/Proiect Type of System (Complete A or B as applicable)
Job ,4 .` S t&4 ne
Address A m 7 0 nal dt A.) Sprinkler Wet DfY ❑
IC A Standpipes r/
L�- [/d�ir l li �/ - % / Hazard Group
re
Owner Mailing Addss Additional
330 %/2- tift, 1-= Ae Information De^s't'
city eiv � P�5 -0-04,1 aZ Design area Del
(,Q�
Name
K. Factor
Occupant Mailing Address 3, f
Cit Zip Phone Sprinkler Project Valuation 1 $ / 7 () / �7 /
COT Business Tax or Metro # Exp. Data B . ) Fire Alarm I , 41 K. ?0 •x, 1 1 ,-
Submittal Shall Include Battery Calculations YES 0
Contractor N e ,
a. ..e1. 1.L e.a TN& Individual Component YES ❑
(Sprinkler or ding Add s Cut Sheets
Alarm ',8 fi t � L. Vh1 � S j Fire Alarm Project Valuatton $
Company) City/State Zip Phone 360
k)� Q 8ido3 6 zv.-7 Project Valuation Subtotal (A or B) $ y
Attach 0/0 2-3 nt. Board Licit E�xpga =e�, , l' ?gt 0 / 0 l Lir
Current COT Business Tax or Metro # Exp. Date Permit fee based on valuation $ Of � �
,9 Licenses (see chart on back) it):
N me — 5% Surcharge $ # 1-
-
t � FLS Plan Review 40% of Subtotal $ 7 ? � ,
Architect Mailing /t6-0^/ ,_ [< `
City/State llfdei ( G Y ne 7 0 TAL $ / ; e ► ;-�
Descrbe work A.) Newt Addihon 0 Alteration O Repair O is MUST BE SUBMITTED. approved and a permK issued prior to ins anon.
Three sets or plans and site plan (and vipri,ty map) regwre0 shows I0e21ti0 or
to be done: neatest hydrant
B.) Basement 0 Hood/Vent 0 Spray Booth 0 t hereby acsrnowiedge that I have read bus application. mat the intom+anon given -
Complete tl . Partial 0 Exitway 0 comae. Nat lam the owner or authonaed agent of the owner. and that plans suamttiea
are in Compliance with Oregon State laws.
Additional Description of work: 4 0/49 /2E S !n;
P Sig R of er! � er Date
SY� — AI FP!-� 132 . I / - 7' -97
Al In Existing Building p New Building CC Pe on Nam Phone 36 a
Building
Data B.) Commercial 0 Residential FOR OFFICE USE ONLY:
. Plat* Map/TL#:
No. of stories: .� .� „ i
Sq. Ft: ^ a 5:9 j Notes
Occupancy lass., • Type of C nstiuction .
icsts\firesupr.doc - cell
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