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13125 SW CHIMNEY RIDGE STREVX
CITE( OF TIGARD
DEVELOPMENT SERVICES
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171
61 t
I
!'Y OF TIGARD
Plumbing Application Rrcd By
25 SW HALL. BLVD. Commercial and Residential Date Recd
3ARb, OR 97223 Date to P F.
i3) 639-4171 Date to DST --
Pemut rl
All C z
Print or Type Related SWR t
Incomplete or illegible appiications will not be accepted Called
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Nams of C`-tloprtienVProlect FUFt1:4;Q11dIWdWI) %- p
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Job sk* _ ?.00
address Street Address s,,,1s LAvalory 9.00
9.00
N zS 5nti) C N I M t4E -I Tuts or Tub/Shower Comb.
Bldg a City/State �Zlp Shower Only `+---
1 9.00
2 Z 3 whtw Closet
Nam 9.00
1 =►�AP��` CtA rZ k�` Jtshwarner e.00
Jwnftr Mailing Address Suite L_Garbage Diepoaal - 0.00
13I-; 5...) GK I Mµ! Qt AASchli+e.�
9.00
City/State c p Phone Flow Oram T' 9.00
ej') q°G1
Nance r v 00
�Ykv s•
9.00
;CUpant Me"Address Suds Water roaster- � 9.00
Launtrry Roortt Tray 9.00
C1tyrState Llp Phone Urinal
_ 9.10
fy� other vortures(Sps ) "� 9.00
,redactor mailings ""- - 9.00
12585 SW Pacific t�. _ - 9.00
r to issusrxr City/State tigaraEplugril, — 9.00
jplk'�ant m•_c G-24-738 1 9.00
•m ride ad Gregor Const.Cont.Board Uc* Exp. Date 9.00
an'.ttcdors L,,x�y
lcbr4 F-vurnbirig UcU .a Exp.Oats - Sower-
Ist 100'
torr.utbn2-1-,-:-:," _ 30.0G
cath additional 1t1U' ---
'or COT �G0T Tax w Metra t - 2 •00
Exp.Date Water Service-1 st 100'
ttabasa� �� I
Name— Water Serwcei-each additional 200 - 25.00
chitect Storm 4 Ran Oram-1st lar —" 30.00
or Mailing A4dnm suds Storm d Ram Drain-each aMMonal lar - 25.00
_ M131)"Home space z'.�J
I
1 nter CAyrstato Zip Phone - r�
9 arxnerLlal Back Flow Prevention Dewce a Ant}. 25.00
Polo idon Device _
t>w wrxit New 0 Addition O Aderabw O Repair G R►.sidenoal Backflow Prevent{on Ds�nce' 15.(0
lone: Residential O Nor..respenhal O Trip or Waste Plot -
;atonal desrnption of work - —_—_ �^Y P Corrtected to a Fixture y /0 —
Catch Basan^ - 900
o
�
Insp. f Exrs '—
l-.PLA-CF: l�_�l'� ting PhtmWnq <0.00
per/hr
19 use of -_ Specialty Regtxsted Inspections -� a0-00
ng -,txooerty—, k�'-L� benhr
-- Ram Dram,single family dwelling--- 30.00
csed use of Grease 1'raps 9.00
ling or property_ _
--_�— - --^ QUANTITY TOTAL _
rou Capp"—_ '—_ Iaor.tesc O roar �I�•.,y .^.
. mowing w replacing any ftxh.res� Ye�d YNo C Pegram a reputed Q Quantty Total u >9 �...r. .� :•
yes see back of form) 'SUBTOTAL
mreby acknowledge that I have read this applicaticn that the information
n a correct,that I am the owner or authorized agent of the owner.and 5% SURCHARGE
'r�,;: rs submd_ted are in comolit wtM C on State Laws
nature�(1LtTvnerfAgent Dam —f PLAN REVIEW 2S% OF SUBTOTAL
-'�� - f�/� I 4enuntl aruv I'trnxra oty �aW a>9-.-. .. :
_� /� TOTAL _
rdact Per_nn Mar*. I Phone _ �- A-
'Minimum permit fee rs S25 • 5%surcharge,except Restdenoal 8atk1tow
Preven Don Device,which is$15•5%sur,�Marge
I:1p1mapp.doc 12.96 (dst)
_LEASE COMPLETE AS APPROPRIATE TO PROJECT:
Fixtures tj be capped, r roved or ,replaced Qty
Sink
Lavatory _
Tub or Tub/Shower Combination
Shower Only _
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
_ � 3"
_ An_
Water Heater
Laundry Ronm Tray
_Urinal _
Other Fixtures (Spenify) +
'OMMENTS REGARDING ABOVE:
I:`pl rapp.doc 1-1.'96 (dst)
CITU OF TIGARD BUILDING INSPECTION DIVISION
24-Flour Inspection Linc: 639-4175 Business Phone: 6304171
611 J
1'-
Date Requested: —(Q 7 _UUA M. P.M. MST: 7�'
_ BUR
T:Want Suite: Bldg: MEC:
Contractor: Phone: &.�_ — 73 8 1 PLM:cj 7-- 0 3.D-
- Phone:
.` Phone: 510 _LqS'�_ r ELC:
ELR:
_ SIT:
BUILDING BLDG(con't) UMBfN_G MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Cover/Service Sewer/Storm
Footing Roof ilndFVSlab Rough-In Ceiling Water Line
Slab Framing Tup Out Lias Line Rough-In UG Sprinkler
Foundation Insulation Sewer �Alood/Duct Reconnect Vault
Bsmt Damp Drywall Storm / Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear/Sheath Fire Spklr/Alm Crawl/Found Dr Heat Pump Low Volt
Approvedov Approved Approved Approved
Appr/Sdwlk Not Approved tAUL,4Fovcd Not Approved Not Approved Not Approved
FINAL NAL ) FINAL FINAL FINAL
Cl Call for r6i lxction O Reinspection fee of S _required before ext)nspection C3 Unable to inspect
Inspector: Nate: