PFI2014-00068 � a
CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12014-00068
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 09/08/2014Parcel: 1 S127DD00100
Jurisdiction: Tigard
Site address: 9730 SW CASCADE AVE 100
Subdivision: 1995-033 PARTITION PLAT Lot: 2
Project: Shane Cc Driveway apron replacement
Project Description: Replace driveway apron panel(9'x 9') located at 9730 SW Cascade Avenue.
Owner: FEES
Description Date Amount
PHONE:
Contractor:
CASCADE CONCRETE CUTTING
3809 SE 131ST
PORTLAND, OR 97236
PHONE: 503-761-3816
FAX:
Applicant:
KENNETH SHANNON
3809 SE 131 ST
PORTLAND, OR 97236
PHONE: 503-761-3816
Total $0.00
Please sign below to indicate acceptance of conditions and return a copy with the proposed work schedule along with names and contact
information of responsible parties before beginning work.
Permittee/Applicant
Signature:
Issued By: Aftm Wit4r
U ,
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
City of Tigard
= r Public Facility Improvement
(PFI) Permit
General Information: FOR STAFF USE ONL0- Y
Property Addtess/Location(s): �'�� Engineerin
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S Q„ Case No.:
(2.0 14
U,� Fee:
(� n Receipt No.:
*Applicant's Name: W 1 t�1 16' � (�`'h,� � Date:
Address: Application Accepted: By:_AlL
City/State: 'Lip:
Primary Contact: REQUIRED SUBMITTAL
INFORMATION
Phone: Fax:
E-Mail: Professional Engineered Plans are required
'1 for:
Sweet Widening
Contractor's Name: 2 4M :
A2
Subdivision Infrastructure
CCB# r q3 Expiration: l 1 I tC/ • r&in utility line extension:
0 Storm Drain,Sanitary—Tigard
Address: 0 Water—Tigard Water Service Area
City/State: �/, C7 Zip: (includes Durham,King City and a
�3 v`iIL�L��i Fax: portion
County)
of unincorporated Washington
Phone: ty)
"Note:See Engineered Plan
Plans By: Submittal Checklist attached.
Address: For all other work:Submit scaled sketch of the
City/State: "Lip: work to be done. (see attached minimum sketch
Phone: Fax: requirements and provided sketch area).
Updated:6/24/2013
1:\CURP1 N\Masters\[And Use Applications\Pubbc Facdity
Description of work U OVI ACC r
lmpruvenmit.dcxx
Estimated value of work(within the public right-of-way): $ ' 0
Is work related to a LAND-USE DECISION? YES [:] NO
If so,please specify(MLP,SDR,SUB,etc.)case#:
Is the work related to a BUILDING PERMIT? YES[] NO
If so,please specify(BUILDING PERMIT)case#:
City of Tigard 1 13125 SW Hall Blvd.,Tigard,OR 97223 1 503-718-2464 1 www.tigard-or.gov I Page 1 of 5
SKETCH ARRA:
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Cite of Tigard 13125 SVC Hall Blvd.,Tigard,OR 97223 503-718-2464 www.tigard-or.gov Page 5 of 5