Permit CITY OF TIGARD SEWER CONNECTION PERMIT
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COMMUNITY DEVELOPMENT Permit#: SWR2015-00167
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13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/28/2015
Parcel: 2S102BC01102
Jurisdiction: Tigard
Site address: 12764 SW KING CT
Project: Graceland,Lot 5 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 12/24/2015 $5,100.00
Sewer Inspection-Residential 12/24/2015 $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, Stale of OR. Specialty Codes and all other applicable
law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if
work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification
Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions
to OUNC by g 232.1987 or 1.800.332.2344.
Issued y: r Permittee Sign ure: `
Call 503.639.4175 by 7:00 a.m.for the next available in on 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.