Permit 14 i =� ii, CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit#: SWR2015 00165
TIGAD R13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/07/2015
: Parcel: 2S102BC01102
Jurisdiction: Tigard
Site address: 12758 SW KING CT
Project: Graceland,Lot 6 Subdivision: GRACELAND Lot: 4
Project Description: Sewer connection for new SF.
Contractor: Owner: PACIFIC EVERGREEN HOMES LLC
7410 SW OLESON RD#133
PORTLAND, OR 97223
PHONE: PHONE: 503-664-6423
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 12/07/2015 $5,100.00
Sewer Inspection-Residential 12/07/2015 $35.00
Type of Use: SF
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $5,135.00
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty C•,es a d all ether applicable
law. All work will be done in accordance with approved plans. This permit will expire if work is not started with' 180 days of issuance, or if
work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted i•,; the "regon U ility Notification
Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a ,.��;�'L he rules or direct questions
to OUNC by calling 503.232.1987 or 1.800.332.2344. �Il�-''
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Issued By: 8.....„....vx......d.,„., ..fes Permittee Signature: IIV
Call 03.: 9.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.