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i 01 0/97 11:52 27503 684 7297 CITY OF TIGARD 10006 /008
ire Protection Permit Application Plan Check # I - I ��
Cl
1TY OF •TiGARD (k6 Commercial or Residential Recd By -+
3125 SW HALL BLVD. Date Reed 1-2 a --17
I GARD, OR 97223 Print or Type Date to P.E. I -2.1 ry 7
;03) 639 -4171 Ext 304 I omple or illegible applications will not be accepted Date to DST I � -- 5-40 lrfJ
15d1—
Called Perrnitii QuPao 07
t/ _ - 7" 9
ame of Devel•pmenVProject (Complete applicable)
Job iifL ,"i 4„ i,/
— Address )° 942. •2, -pie �•�, e ■
N �P
it Standpipes
& :
Owner mailing Addre Additional ,. !
330 /a- = n� — Information Dens
Q City/.
City/State J „ Zia Phone ?.d(o ® Q0!
f (rive 7Gw ei /- cia Desgn
Name
K. Factor Q
Occupant Mailing Address J
City/State Zip - Phone Sprinkler Project Valuation $ 0' 1 0 10 SO
COT Business T or Metro # Exo. Date B.) Fire Alarm 1.40 x 1 41 j 0 4167'161(i91
Submittal Shall Include Battery Calculations YES ❑
I Contractor e f a .y TN& Individual Component YES
(Sprinkler or �,i Add /eps�� lit A Cut Sheets
Alarm 1 k�Yt le `' i Fire Alarm Project Valuation $
Company) Cit /State Zip Phone 3t,
1)131/�L01�11Q4 g ` f . r 6 - 605b."7 Project Valuation Subtotal (A or B) 5 i , - Z
h . Attac o %151 nt. Board Lk.* E�xp�a- — , / % t , • / 17
Current COT Business Tax or Metro se Exp. Date Permit fee based on valuation l'
(see chart on back) t
Licenses 5% Surcharge 1 ��
K1 me t��p-st✓ FL5 Plan Review 4l!% of Subtotal
Architect Mailing 2 10 ' 1p tt ^ WI)
CL Lie &* fW 4' ✓' - 4p T OTAL
Descrbe work A.) New Addition 0 Alteration O Repair O PLANS MUST BE SUBMITTED. approved and a permit issued poor to installation.
Three sets of plans and site plan (and viCnIty map) reteared whiQm stews location Of
to be done: nearest hydrant
B.) Basement 0 Hood/Vent 0 Spray Booth O i hereby ackneveeege that I have read this apprirawn. Oat the Information given is
Complete id Partial 0 Sideway 0 correct that I am the owner or authonied agent of the owner. and that plans suDmrtted
are in compUance with Oregon State laws.
Additional oescrption of Went: t04-77-G FfIZ "P(4114141. Sig • • re of ° r/ • ! ent Date
s W AfFP4 13 ;, ,,�./,, - j / - l6 -17
A.) In Existing Building ❑ New Building Contact Pe 'on Nam Phone —(9 a
Building ' C. ae - .- t'93 'zo S,7
Data B.) Commercial ❑ Residential - FOR OFFICE USE ONLY:
Plat # Maprrl#
No. of stories: . 1 6 S� _ _ -
fir
Sq. Ft Notes
Occupancy ies �� Type of C nsbvction • •
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