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�_ 11575 SW CROWN COURT
C;TY OF TIGARD
DEVELOPMENT SERV:°'EES
13125 SW Ball Blvd., Tigard,OR 97223 (503)6394171
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EXPIRFID
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-IUE 09:20 ID: ! FAX NO: 4010 P03 t _
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--'ITY of TIGARD -- _' Pfumbing Application Cate ey _
13.125 SW HALL BLVD. Commercial and Residential f , U� ��eRecd _
TIGARD, OR 97223 1 1 Date to P t,
(503) 639-4171 Data to OST
(I'I Permit r -•-+-� ,
Print or Type Related SWR a
Incomp'ute or illegible applications will not be accepted caned
-' Harm 01 Leveto(lmanuG►oiest - FIXTURES Iindividual) aTY PRIGHy AMT
.lvb Sinh - 9.00
�'ddregs Strehet Ananss—� Suds Lavatory — 9.00
_Sl . Dor uT NSnower Como, 9.00
Flldg s Cirvislate Zip Shower Only -- 9.00-
Naltts — Water Ctoeet — 9,00— —i
Ch1l.✓�"' � VC:f 1��� �+••asnir I 9.00 J
(�yABf Marra Adanss u," aaroaga Disposal � � 9.00
2+7 I S NoSd _ waslung k4witrns 9 00
jb ZIv Phone -Flow Dram Z' 9.00
Nt�rrua '� f j
(tel'_6,4 1\oi/ ��_ 9.00
Wa(w hlestot
Occupant ��I1eRlrias ^ n? Auhfe _ - 1 9.00
l r /! li1�s _ Laundry Rxm Tn� y a0
City yqa�ry TJp PArwa - - ---- —
Urinal9 00
NanMo��l�� �,/ Cltner Fi,nurea(��petaryl 900
»a. : -_._��i77Ir/l/✓I - 9.00
h�.e7f11tf}�t�tOP Mailing Addneu Suite —"� _� 9.00
�fZtir - 400
att/mtalo Zi noOrtgo
n const.cam.Weara Lies � "
CC" O.00
.rgof _
c4wTwa lac 0 Ex .Dal Se war-tat 100"-T�—��y 20.00 T
r.►cenase (0 _ 3em,tr•eatJt w'•tlticxtal t00' 1 2500
-co uatnQea TaY nr Mavo s E.p,Do a Mater Servide• 1st np' L. —"•I
10.00
Nana water Saru,ice-o to add.honet 200' 25.00
Archltet:t torr-s Rain Dart-ts1 100 30.00
Met Aoatssa Shann�ain Drain•escri aodioona►1w 25 90
Mod"Hornet 9pmr* — 25.00
Engineer c'tlrStata ZIP Pnwo C.c>+hmeresl Aaek�lrn�itwenurn MNo or 4nw 25.00
J+scr +eak Woa O Rion O r11t'ratlnn o
pop t►alrlrntial eadnow Prevenden Usuiee• 11,00
,a 4a dwr.� iesiewW. Monaealoenital o Any Trip or Waste Not C rinacted to a Fwture 900
AdditiwM denixryuon of.ors Catch datun -- -- 9,00
XP i b P r Inap or Eaisung Mullin"
!�[ Derrhr
-:navtp uaa of
--- - ---- Spacaahry r7egwstad Insoecoons
_ penhr
—icirq a pr-pPsrty-..��.�_ ._. _ Rain:'.raw+.anyte'-_ry eweH;ny 30.00 "'1
°Topoae!use of I ?hvaas Tripe r 1 po j
QUANTITY TOTA1.
Ane you npp;ng moving or repiadng any finuresT' Yes L3No Q taomeft er tilt dseo
_ wgmm rurw a Owrtf Total u s 9 _
(ifsy s see!back 4.(form) 'SUBTOTAL
'SUBTOTAL
I n*neDv achnowlaa9.�chat I haw read thin_a,ppi"ion,that Mr infnnnatklrt
;teen hs,.zmed.;not'a.n tnn owner or autnoritrd agent of"o_ ow and 5%SURCHARGE
Mat clans auomrea4 ars in oomotlance with Oregon slaty Laws. _
3;anaa�n of Owneerrnpent Dam �PLAN REVIEW 2S%Of SU 81 OTAL
��---� -7 _ - `—TotAL
.ontoct arson Mama Pltona �'ZI
�- 7 'Minm rm
imupeit fee is$25,Ski Aunjwye.except Residential 8acxnow
C*�y_/16 Prevantlon Cevice.which is Sts* S'L surcharge
' ;-4lhctchelmrnn Ani Mion
1N3Wd013A30 MONO
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''TY OF TIGARD -- -`- �! I
plumbing Application Recd By
125 SW HALL BLVD. Commercial and Residential CateRecy__
s IGARD, OR `31'223 Date to P E
(503) 639-4171 Date to DST_
Permit s
Print or Type Related SWR s
Incomplete or illegible applications will not be accepted Caned-
Name of CBveldpmenUProleC; SFIX.nk TURES (Individual) 1 QTY I PRICE
.dot) AMTT�
9 00
Address Streeel Address Swte lavatory
A,5?s Sig J !:rhlnJ✓I r_�•�_— Tub ur TuoIShower i;omn— T— 9.00
Bldg a C tyrState Zip Shower -
1 9.00
—' Narne 'Nater Closet
'42, s7e 10 f C snwasher 9.00
0"er Hariu,g address suite Gaioage Oisoosal 900
Z•Cl)f SW <nNv� (�, I NasningMachine ( Too j
Cslate Zip I Phone Floor Crain 2• 1 t- 0-0--� —!
NOR* 3'' 9.00
Occupant Meng Address Wa
r/� n Suite ter l seater ` T 900
-,
C L' ` 1' �r1 G�• Laundry Room Tray --- --I} 900 y�
C•t/y/State,+ l ZiP I Phone
�7722t^ I ��CJ -C�7S' urinal _
9.00
Mot� Ncm ` Ctner Fixtures ISpeuh�)
I � � � � 9.00
'
Cariftctor Mailing Address Suite —' 9.009.00
t �uS�S st✓ f�uGl�, c
— ---
Gty/5tate Zip -�� Phone 9.00
C on Const-Cont.Board Lic.x Exp Pate A 9 00
Ail och copy of -7 L (O y k 7 9.00
PI"a7b'7 Lic.= Exp.Date Sewer• tst 100'
4
COT eSewer-Daum additional 100'Business Tax Tax o+Metro Exp.Data
water Servrcxi• Ist 100' I 3000
Name — Water Sernce•each additional 200'
25.00 i
Architect Storm A Rain Drain- tst IGO' 30.00
{ or I Mailing Address e — Stcnn 6 lain Crain-i anti adtliuonal t00' I 1 25 00
� �-- Mobile Home Space I 25 00 I
t
Engineer L ryrState Zlp I Ptic to I I 29 00
Commercai 9acx Flow?evenucn CevtCe it Atilt-
Cev,ce
Deavrbe won New O Addition O Alteration Q Repair Resuienual BarJcflow Prevention Cev ce• I 15 00 1
o be done: Residecriallid— Von-residential O Any Trip or Waste Not CanneaM:o a F xture 1 — 1
_ goo
+ddrtx,nal desrnFt:on of won _
l Catrh Bann
!rm of Exlsurg P!umcm9 I Lao QO
ceuhr
..vsnnp use of — — Sceaaily Requested lnsoec:;ons •+0 00
.skiing or pro Polly_, _ ____L_ I oerrhr
---- Rain ;run,single family dwelling I I 30JO—i
`*noosed use of --� Grease Traos I 9.00
%ilding or Property I I
CUANTITY TOTAL
Are ycu �Pping, moving ar replacing any fimures1i Yes O No Cl_ 'scmetrc:.r riser--+arram s recuireo i Cuan
(if
yes see back of form) _ _ ----'SUGTOTAL `1
I hereby acknowlecge that I ha•.e ead th s acolication,that the information
ven.s cor.-ea chat I am the cwner or authorized agent of the owner.and I T 51,:SURCHARGE
Tiat etaru submitted are-n compliance with Cregon State La,.vs
Signature of Owr.enAgr'�nt��/sto PLAN RL .EW 25': OF SUBTOTAL
7ty .Val s
TOTAL '
Zontact r Name Phone
��'_.7T Minimum permit fne.s 525-5'.:surcha ge. except Residential Bacxflew
i l!,[��__— 4 / Prevenoon Cevice.wh vi.s Sts-514 surcharge
i:',d*tstplmaop.doc 3'96