8395 SW COLTON LANE ...........
8395 SW QQLT'ON CT., 7-ICa,4RD' OR
LOT 4 OF DURHAM OAKS SUBDIVISION -- _W
- W4TER L ATER4L
d SEWEIR L"TER,4L
----; F-- _ &IL T FENCE
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PLANT LIST
w MITIS i<aTI�Jf J TREE FIR
3" TO 4"'P (MEASURED AT 54,5E '
y = RR0F06EC.*) STREET TREE -4L= --4. TOTAL IrJC�-!E5 3" x = 1&2" CEIVED
/-%<EENC' F
0LC WERIt IG C:HERR T r :: F~ER LOT )
-OE
T - I"11TI6ATION TREE - -4' T(..N 5' AR50RVITAE FEB 1. 1 2004
= E IaTIf�JC� t°R'EE T` E y,a ED AT 2 S' mac. D14M = 21 " TO 3" (MEA5URED AT BASE )
`" TOTAL = TC., THL. INCHED - _ " ;. 33 -- 47� CIT`! OF T�a�[�[.:j
BUILDING D i V I S 1014
SITEPLA NORTH �
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DURHAM OAKS SUBDIVISION — — P",'RTLANUIP `n, 97219
SW DURHAM RD AND SW HALL BLVD TIGARD, OR 1603) 4W3-6033
W)'F' PLAP I'AI.`:: 1550 .0 444-2,'44J
C?�.IE rG�4
NOTICE: IF THE PRINT OR TYPE ON ANY T
T
2(IMAGE IS NOT AS CLEAR AS THIS NOTICE 3IT IS
III ITI IIIIIII III T !
ITT
DUB: TO THE QUALITY OF THE --
_ _ No.36
ORIGINAL DOCUMENT --- --- _ _
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8395 SW COLTON LN
�I i Y OF TIGARD MASTER PERMIT
PERMIT#: MST2004-00041
DEVELOPMENT SERVICES DATE IgSUED: 3/2/04
13125 SW Hall rllvd.,Tigard,OR 97223 (503)639-4171
SITE ADDRESS• 08395 SW COLT-ON LN PARCEL: 2S112CC-D0004
SUBDIVISION: DURHAM OAKS ZONING: R-12
BLOCK: LOT: 004 JURISDICTION: Il(i
REMARKS: New SF detached.
BUILDING
REISSUE. hm'61;� STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED _
CLASS OF WORK: NF Vv HEIGHT: ., FIRST: 636 sf BASEMENT: sf LEFT: SN,OKEDETECTORS. v
TYPE OF USE: SF FLOOR LOAD: a/I SECOND: 1.040 sf GARAGE: 305 sf FRONT: IS PARKING SPACES
TYPE OF CONST SIJ DWELLING UNITS 1 T11RU sf RIGHT: `
,
OCCUPANCY GRP H3 1 BDRM� 1 BATH: TOTAL: Ir! VALUE: 163.061 3U
', sl REAR: 15
PLUMBING
SINKS. I WATER CLOSETS: 3 WASHING MACH: ' LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS
LAVATORIES: DISHWASHERS I FLOOR DRAINS: SEWER LINES, Inn SF RAIN DRAINS. I CATCH BASINS
TUBISHOWE.RS GARBAGE DISP: i WATER HEATERS: I WATER LINES 1(fl) BCKFLW PREVNTR. GREASE TRAPS
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN<10OK: I BOILICMP c 3HP VENT FANS 4 CLOTHES DRYER I
FURN>%100K: UNIT HEATERS: HOODS: 1 OTHER UNITS:
MAX INP. bill FLOOR FURNANCFS: VENTS- I WOODSTOVES. GAS OUTLETS. l
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS _
1000 SF OR LESS 0 -200 amp: 0 -200 ampWIS VC OR FDR: PUMPIIRRIGATION: PER INSPECTION.
EA ADD'L 5005F. 201 400 amp: 201 - 400 amp- let WIO SVCIFDR. SIGNIOUT LIN LT. PER HOUR-
LIMITED ENERGY 401 - 600 anno 401 - 000 amp EAADDL BR CIR SIGNAL/PANEL: IN PLANT:
MANU HMISVCIFDR. 601 1000 amp: 601.amps-1000x. MINOR LABEL:
1000♦amplvolt
PLAN REVIEW SECTION
Reconnect onry `-
-4 RES UNITS. SVCIFDR-225 A. 600 V NOMINAL: CLS AREA/SPC OCC.
ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDENTIAL R,COMMERCIAL
AUDIO 6 STEREO: VACUUM SYSTEM, AUDIO 8 aTEREO: FIRE ALARM. INTERCOWPAGING: OUTDOOR LNDSC LT.
BURGLAR ALARM OTHBOILER: HVAC. LANDSCAPEIIRRIG: PROTECTIVE SIGNL.
GARAGF.OPENER: CLOCK' INSTRUMENTATION: MEDICAL OTHR
HVAC: DATA/TELE COMM: NURSE CALLS. TOTAL 0 SYSTEMS
Owner: Contractor: TOTAL FEES: $ 7,264.61
This permit is subject to the regulations contained in the
BUENA VISTA HOMES BUENA VISTA HOMES Tigard Municipal Code, State of OR. Specialty Codes and
6932 SW MACADAM#C 6932 SW MACADAM HOMES all ot'Ter applicable laws. All work will be done in
PORTLAND,OR 97219 PORTLAND,OR 97219 accord3nce with approved plans. This permit will expire if
work is not started within 180 days of issuance,or if the
work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by thi
Phone' 503-443-0033 Phone: 50?-443-6033 Oregon Utility Notification Center. Those rules are set
forth in OAR 952-001-0010 through 952-001-0080. YOU
Rep N: LIC 1522?5 may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1987.
REQUIRED INSPECTIONS
Ersn Cntrl 681.4444 PostlBearn Mechanica Plumb Top Out Exterior Sheathing Insl Rain drain Insp Electrical Final
Sewer Inspection Underflour insulation Electrical Service Low Voltage Storm drain Insp Mechanical Final
Footing Insp Crawl Drain/Backwater Electrical Rough In Gas Line Insp Vlater Line Insp Plumb Final
Foundation Insp PLA/Underfloor Framing Insp Gas Fireplace Water Service Insp Building Final
Post'Bearn Structural Mechanical Insp Shear Wall Insp Insulation Insp Appr/Sdwlk Insp
� � l
Issued By _-!'� r_ t c2cC 1C - c L (� _ Permittee Signature
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the ne t business day
I
CITYOF TIOARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2004-00042
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 3/2/04
SITE ADDRESS; 08395 SW COLTON LN PARCEL: 2S112CC-D0004
SUBDIVISION: DtIRI IAM OAKS ZONING: It-1_'
BLOCK: LOT: 01).4 JURISDICTION: II(;
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new SF
Owner: FEES
BUENA VISTA HOMES Description Date Amount
6032 SW MACADAM #C p
PORTLAND, OR 97219 ISWUSAI S%%i Connect 3/2/04 $2,400.00
SWUSA I S%�rConnect 3/2/04 $0.00
Phone: 503-443-6033 1SWINSI11 Swr Inspect 3/2/04 $35.00
jS1ti'INSI1j Swr lisped 3/2/04 $0.00
Contractor:
Total $2,435.00
Phone:
Reg #:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180
days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee
the accuracy of the side sewer laterals. If the sewer is not located at the measurement a;-;qn, the installer shall prospect
3 feet in all directions from the distance given. If not so located, the installer shall purchase a "Tap and Side Sewer" Perm
f �
Issued by; _heti-L ' -�. :LL(;t-c� Permittee Signature
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next b iness day
I�
Buildin Permi ation
y Received Building
eY/r r._
Date/By' c� �J Permit No.: h, mo
City of Tigard [ lam.U Planning Approval Other
FFfI
Date/By:: Permit No.:sWQ 0[b y'
13125 SW Hall Blvd. U ' �
Plan Review Other
Tigard,Oregon 97223 rl'p,� �U4 Date/By:: /fI� V Permit No.:
Phone: 503-639-4171 6U�1 r{F, Post-Review Land Use
Intemet: www.ci.tigard.or.us /[//S/o Contact 2 —
Case No.
4-hour Inspection Request: 503-639-4175 Ju See Page for
Name/Method I Su lementallnformatlon
TYPE OF WORK REQUIRED DATA:
New construction Demolition _ 1&2 FAMILY DWELLING '
Addition/alteration/re lace-ment Other:
CATEGORY OF CONSTRUCTION Note. Permit fees•are based on the total value of the work performed. Indi,:ate
1 & 2-Famil dwellin CommerciaVIndustrial the value(rounded to the nearest dollar)of all equipment,materials,labor,
Accessory BUIId111 overhead and profit for the work indicated on this application.
Multi-Famil
Master Builder Other: Valuation................ . S
. .............................. ........
JOB SITE INFORMATION and LOCATION No.of bedrooms: No,of baths:2s 5
Job site address: y J v Total number of floors..................................... --
Suite #: New dwellinb area(sq. ft.).............................. _
Bid ./A t.#: Garage/carport area(sq. ft.)............................ -
Project Name: Covered porch area(sq. ft.). .............
Cross street/Directions to job site: Deck area(sq. ft.)............................................ EV
w� 1,G•�1 �1�,� „v 1 D������ Other structure area(sq. ft.)............................
fl Vv
REQUIRED DATA:
Subdivision: COMMERCIAL-USECHECKLIST
Tax map/parcel Note: Permit fees•are based on the total value of the work performed. Indicate
DESCRIPTION OF WORK the value(rounded to the nearest dollar)of all equipment,materials,labor,
Lct 1I I Q ,/D overhead and profit for the work indicated on this application
6LI3-- ur r Valnation. ....................................................... S
Existing building area(sq. ft.).........................
New building area(sq. ft.)...............................
Number of stories............................................
PROPERTY OWNERTENANT Type of construction......................I................ —_
Name: S Occupancy group(s): Existing:
Address: JQO(727 ",AA) _ New:
Cit, /St to/ZiR iA Cl —
Phone: �ja tax; NOTICE: All contractors and subcontractors are required to be
APPLICA C NTACT PERSON licensed with the Oregon Construction Contractors Board under
provisions of ORS 701 and may be required to be licensed in the
Business Na;ne: jurisdiction where work is being performed. If the applicant is exempt
Contact Name: s~ from licensing,the following reason applies:
Address:
City/State/Zip:
Phone: _�Fax:
E-mail t BUILD11NU PERMIT FEES*
CONTRACTOR
Pltitiu re�iet`to�teeiichaltile.
Business Name: S
Fees due upon application.............................. S
Address: --
City/State/Zlp: Amount received............................................. S _
Phone: Fax: j _3 Date received:
CCB Lic. #:
i
Authorize
Signature: Date ��J l Y/p�ice: This permit application expires If a permit is not obtained within
��-- "1�0 days after It has been accepted as eompletr.
�— -- /•Fee methodoloIDset by Tri-County Building Industn Service Board.
(Please print name)
HDsts`•Permit Form\BldgPermitApp doc 0103
01/20/2004 16:22 5032537693 SUN GLOW INC PAGE 02
ecbanic Permit Appligation 7PIAMMAN
cind Mecbmits
r��'\ J P—tCity of TigardR 4L• V Apmviil --- sullautg
Datdl9 ; PttretitNo•:
13125 SW Hall Blvd. 1 It W P aview Otber
Tigard,Oregon 97223 F tFs 1 ,� 1l U , � � 1 LaQndlUae --—
Phone: 503.6394171Fair` Cue No.
Internet. www.ei,tigud*-Its` Pa on
V ctact luno.: gee v 2 for "
24-hotu Intpectioa ltagpq��t_�11l1�$�I� IC .
N1rtte/Mcthod: 9n Iemr.,hllnrereytlen.
New con9buction _ Demolition Mechanirxl perrrnit Nes•are based on the total value of the work
AdditioN_ttlttxation/re laeernent Other: ( prribrmed. Indicate the value(rowided to the ccarest dollar)of all
--CATI;GDRT --RuEMON,4: mechanical materials,equipnwt,Irber,overhead and pmfic
l &Z-Famit dwellin CommerciaUlndustltial vclne: S � See P.ge 2 for Fee 5cbedule
LE
Accessory BUildin Multi-Fatnil DeMiotiva Fee n, Traeal
Master Builder Other: _ H ,te/cootw4
ro S1T�I R T[ON as �Ib Furnace. add-on sir conditioning"_
14.00 -_
Job site address: Gas,'�t�l beat pip 14.00
Suibc#: _ Bl /A t.#. Duct wotk 1400
Nject IVattle: f la �` - H dxonle hot waw system T T to o0
Residential boiler —
Cross street(Directions to job site: tar radium oar h)drvnic eyetam) 14.00
D' ' '/ G_, •_ n� �� I� 1/l� Unit allure(fuel,not� c)
in wall,in-0uct,swd94at1,etc.) 14.00 �
{I _Flustvenr Oor,any of above) 12-
- - -- units l 2.t 5
Lot
#: -t Uther F■ts Ai�tlaaoa __Tax MAIP/Owel#: Water hearer 10.00
()1�1 OF VM Gas fireplace -- 1 .
Flue vent ww hwCOS"nrtplace) 10.00
li ar gaZ-- -- 10.00
wood?elkt an 1_0_._0_0_
�/ _ ) Wood fire lacehrsen 10.00 i
___.� (ltitxnoy/llhes>< arc/vent
)e)[1OPP.RTY R
U'1 UN Otnet: I _ 10.00
N ra.ne: - 1 � ( c � F_mirot►tneau'I fitawt v
Range hood/other kitchen equipment 10.00
Address_ cl°thy dryer PYh�u9a -- 10.00
city/ terZi 5�11`lY I' Single duct eahttust
Phone: > ✓- RX: r (bathroottts„toilet aampar*tnents, 1
CANT- -- — COMACT MRSOIY - utili rooms -- 6.80
Name: 1 Attic/crawl SWe Cay 10.0
Address: `1 < Oth -- 10.0.1
Cit /S te/7i _ -•"( .4o Lor firif 4.S W eee6 tWtliti0ge�
Pomace,etc, •"
Phos 'u Fla — — ..
— Gas heat_ c�M
lr-rRBil: Wehh_ is ep�tdod/urtit heatst " ,_
CONVTRAC[OR Water heater `'
Business Nater. �1�- Fireplace ---- _ ••
Address: Z Z- �.Q � _ BBQ
Ci /State/Li : 1,.
--LLE ( Z & clothe drnr(gash -- - •. —
Pbone;�:r�, "_1? U k -253,7 [od,t r _ ..
CCD Lic, #:�` 1°tat` ----
Authorized ) �•
!� ()�� \i Otte � t-� Subtotal: S
Slg�sature.C` ( j .._ inimum omit ffto 972..50 S
Plat+Review ec 25%of Permit Fee)
- ieaae t name) - ---- Scete Surch 194 ofta tit Fee S
( 15 YOTAL rEPMri FXF S i
rCtlre: Thu ptrtnit applitAttoo 4MR400 if■petM:t k mat*"Ulnad within fro ntethpduto►,y set try TrTCmatlt. Sulyd3a�Industry Servtn @oard.
180 days anrr it hos Dere saepttd are etatttPtete. Site plan reetolred rer ntrrier A/C unhc-
i:lJsts�Pe*m,•P°mu�btrrPmnitApp.dtx Ol/t)�
01/2o/2004 16 03 FAX 5036284633 1HF MULLFN COMPANY QJ 002/002
PlumWina Permit
_APIP-1Dication ,,rceived ,�„�;�s A
.WDy. _ Permit No.Yt _ oy�o
City of Tigard Plannitt{Appwtil Sewer
CEI, / cx Permit NO:
13125 SW Hall Blvd. V V Plan avlew ot},rr
Tigard,Oregon 97223 DaGe/B, MY: Permit No
Pbartc: 503-639.4171 Fax: 503.598.11" (J ' Pat-Revlow Land Use
e
Case N
inttraet: .
www,ei.rigard.or us Ata/$Contact Jt.H1.: sex P■g
24-hour Inspection Request. 503-634jfSOF Name/Method; e=Tor
6u �eete■t,_� t r�t,r�,doa
B '1 DING DIVIS10N
T"llt.OF W01tK FES•.SCi�ptlLE t f 101
New CO
nsauction DOm 'tion Descri tion !*C-,) Total
Addition/elteration/ro lacement Cher: '''' `''�' •;, >� ',� '
----- OH _ '' tiii�IuP� il� 'i�":''k',•,c`"``�
1 & 2-Farnitydwellil Industrial Commercial' SF 2 9,20
SFR 2)bath 350
Arca esMr auilding multi—FamilySFA(3 ot}t 399.00
1Vla8tCC H1t11GICT Other: l'ssth additional bath/kitchen p0
8RE O TIOK•srtd F(ro sprinkig-sq.tt: Pae 2
Job site address: 111W us
Suite*• H1d ./A t.#: catch balawaroa dnttn .60
Project Name: oll/Inch line/ftach dtiln 16.50
Cross street/Directions to job site: Footing dein no,linear ftp pe 2Manu 110,00
��wr �vr ► [<d 4 N a I 1 Vd md"0>ta o _ -- 16.60 ---
Rain drain connecter 11'60
Sanimry sewer no inear - Pa c 1
' Storm scwci (no.luxar ft.) Pa c 2
Sut�J v Lot#: �__
Water service no. linear f). Page 1
SCREMOKOKWORK Eirtltre or Item
� Abeo N n valve _ I6.60 .
Backflow proventer P e 2
awkwager ValVJ 16.60
Clothes washer 16.60
Vishwashar 16.60
P®QP1i�tTYO Drinkin fountain 16.60
E xtots/c 0
Name: Ex ansion tank
16.6
Address: I Fixturelmwer c= 16.60
Cl /Stato/�l Floor iwfloor tink/hu 16.6
Phone; lJ Z - Lp0Fax:' ciGarb a die oval 16.60
Ease bib _ 16.60
�O TIsRGSON We maker 1660
Vie! Y' (�/1 11'1 Interco ter! ease tr16.6
_Addrft§: 1 i C � Medical -valuc, S Pafe 2
�"-u—- -� _
[�/$tlitte/Zi ; Primer 6.60Roof o ercial' 16.60
Phone: 5C� I U lQ Fax: i �. 1 r �s�nk. evato - — 1610
E-mail: ll')f_e) - C Tu4 b/showeeshower pan 16.66
_ WNTRACTOR Urinal 1660
Business Naznne: -- r` atcr closet - - 16.60
LI
Address: -" motor eater — ----- t 6:60
Ci /State/Zi ,Z other
Phon SO' F o utimu _
CCD Lic. #: lumb. L. -26U � Subtotal 5 _
orizcd _ Minimum Panrut Fee$72.50 $
Au RcsidentW Backflow Minimum Fee S34.25
PW Review 15%of Permit Fee s
Fee S
"(plesif print name) TOTALFERM 9S _
Notlet: TWA permit appllaw aapiro if a permit is not obtained within All dewy eeeaenertial bvlldlop r'edulre 2 sett or plant with Isometric or
160 days after it his beer tewpit4 as eemplete. riser diaLgraita for plan+tew.
•Fe+methedotoa set by Trl-County rtulidln f tnduttry Service board.
f,,,Dsa\PermitFor"%5\Pl-nPermitnppde,e o1ro)
01/20/2004 16:08 1j36425815 ROSS ELECTRIC INC PAGE 01
Electrical Permit Application ��;�� el�>m
rical—
DaWa : Permit No.: –000 r�
City of Tigard Plannmg Approval Sir
13125 SW Hall Blvd. V E b7;'t : !Merit No.:
Plan Review
Tigard,Oregon 97223 Date/By: Permit No.:
Phone: 503-639.4171 Fax: 96 Post•Review Land Use
Internet. www,ci.tigard.or us '3�h59�1, [ 04 Date/13y: F:�!g
24-hour InspectionRequest; 503.03?-4175 Contact ttwd. Pelle 2(br
ent@I Informetivn.
BUILDING DIVISION
_ TYPE OF WORD ' I'it+AN RSYIEW (tttllra chee�a t,thst
New constructionDemolition service over 225 arms. Halthtart facility
Addition/alteratioMe lacement Other: e"`rvice v Huardoua location
CA�TEGOR ON"cotr MON - L7 Service over 320 amps--ting of �Building over 10,000 tquwv reN�
1 h 2 n rnilyover dwellings four or more residential unit,,;+n
] &2-Family dwellingComm_ercialadustrial I ❑System over 6tx)Volo nominal one structure
Accesso!y Building Multi-Family ❑Building over three stories ❑Feeder.,400$rips or snore
❑Occupant load over 99 persons []MICuf lch=d structures or RV park
Mastcr Builder Other; L]Egress/iighting plan p Other
)s 8i'rE ORIHAITI N ivad L e�TION submit_sets of plana with any of thM above.
Job site address: L The above are nota II ble to ra eonstrocdon service.
_ Ali v y
Suite 1F: $id ./A t.# I Number of lata "flons er ermIt Allowed
Pro ee3 t Name 5 Desert tier Qty Fee(ea.) Tom
Cross street/Uirection5 to Job site: New reswelelal.alalle or meal-family per
��n A/ /, nn (� dw•elliaR Melt.fueled-attached gare",
/vv �uv1' r l 1`d -4 N/A I ( �Jl U� I set*,lethided:
V� I� •�atw _ 14513 a
J F•aeii addm� sq. or portion thereof 3.40
Subdivision: rr�t Lot#: ' Limited .�i 75.00 2
Y_4 Lnnited ratM non rmidential 75.Op 2
raX map/parcel#: Fach manufacrurcd home or modular dwelling
VES_C ON OF WO - -� Service and/or faedtr 90 q0 2
mnlu rvlcas at feeder-Iastsl;atioo,
Alteralba or reiootloat
oo am ,of lest go.5 2
— 2n I am to 100 am 106. '- 2
401 attlDl Cs 600 area I ,60
PROPERTY OWNIER TEIsF �I�to 1000_x- - 2
Over r 1000 am or Vohs 454.65 `� 2
�-, li �._. R<tatttect on 66.15 2
Address: Temporary services or feeders-installation,
CI /S te/zi : Ot ■Iteratlnn,or relocation:
y J 1 I m0am s ,Mess WIA I
Phone 02 Fax 0M�to 400 amt+t - 2
APPri.I CONTACT PLIMN 401 to amp, — l- 2
Branch circeitt-new,alteration,or +
Name: Y ealentlae per panel:
Address: Q , A Fee for branch circuits with purchase or
�•G mance or feeder fee each branch chsu 665 2
(.i /Sia4 /Zi B.Fee for branch circum without purchasc of
Phone,rjC% Fax: - Z��� — ce or feeder fee•feat branch circuit 4n.55 2
Each itional ch circuit 6.65 2
E-mail: ry1P � C 5• C1Y) 1-119c(%emlce Of feeler not me a-T ded),-
001tPCRAICTOP. I_._P D m it"-JMm ctrcle 53 40 -- 2
Job No: - -- each i or outline l{ htin 2
Signal cirowt(s)or a limited energy panel.
PSsiness Name 0$S Gum / � ---� Description
escrior eztenaian 2 2
Address: {� 1 :Lti_
Cl /State/Zi �-�— Each edditlonal 1P1e!"ioo over the allowable in an of the above.
PtrP hone_,SZt3 eo`�Z 2 ;?O Fax: ��� hour nem. l hoe -- 62.50
'�_-s lS tnvp�tion fee
CCD Lic. #_1�'76�/ -_ Lic, #: 3�,� Other'. -
Supervising eleetricia _ er*t !;,
si ature re uiredM. ,4;' Jzevo So .
S
Print Name: Plan Review(25%of permit_Fce $ _
V UC I c'OS S Lic. #:a 2 , _ State Surch a 8%of Permit Fa S
Authorized TOTAL PERMIT FEE I S
S+gnature _ ._5�-7_ Datc. _j C 1 N ties: This permit application expird If A permit is net obtained within
i+f9°days eller It hu been accepted a+complete.
re methndolely set by Tri-County Building lndugtrV Set-vice Board.
(Plce�c pri�l-amt) - -
i\bats\Permit Forms\F_lcPe"lApp.d , 01!03
SEE 35MM
ROLL# 22
FOR
LARGE
DOCUMENT