13274 SW BENISH STREET-1 f
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-t?37zf SW Toland St. '—
-7PECTION NOTICE
G�/,f7fL/ Ty of Tigard Building Depar!ment-
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639••4175
Type o Inspection
D,ate Re wasted Time. A.M.__K P.M.
Address __ '• _ __ ___ Permit #
Owner Lot #
Builder —L_ +�-4�'�J�b��� f _. -- --- — -----
The following Building Code deNcieneies are required to be corrected:
Presented to _
/ Approved
Inspector C? � — — --
�.� Disapproved
Date � -
CALL FOR REINSPECTION
❑ YL! C7 NO
INSPECTION NOTICE
City of Tigard Buil,ling Department
�
,���,, P.O. Box 23397 xxl gsrd, Oregon 97223
Phone: 839-4175
A
Ty'tie of Inspection _����' .��-! --------------
Date Requevted_ ��l/—�U me--_-- A.M. P.M/.
Address �` t--—� Permit
Owner .-__ -- Lot # �_
Builder -------
The following Building Code deficiencies are required to be corrected:
— Z
P*esente,l to ❑ Approved
Inspector Disapproved
Date s,L,%7
CALL FOfl REINSPECTION I
YEI O NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223 • —
Phone: 539-4175
Type of Inspection /,
Date Requested r �G! Time A.M. P.M.
Address ___ 06
e� LZ_ r��� Peit
yy�
Owner-_-- -- Lot
Builder
The following Building Code deficiencies are required to be corrected:
4" Aoi
-— ---
i
Presented to _ ❑ Approved
Inspector ❑ Disapproved 1
Date
CALL r'OR REINSPECTION
ED YES O NO
INSPECTION NOTICE �J
f Tigard
City o ga d uil in D Building g epartment
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date. Requested �✓-7=� Time A.M._._ P.M.
Address —. Z oy ---"J -- Permit # L LZ
Owner ____ _ Lot #
BuilderThe following Building Code deficiencies are required to he corrected:
Presented to Approved
Inspector Disapproved
Date
CALL FOR REINSPECTION
❑ YES ❑ NO
CITY Off' TIFA i Cl ROCCUPANC OF
OCCUPANCY
CTTYOF TWA RD PERMIT N. . . . . . . a OUPS91423
COMMUNITY DEVELOPMENT DEWTOANT opeooa PRIM. PERMIT #. a 591425
13126 SWHall Blvd. P.O.Box 23397,Tigard,aegon97z23(6W)839-4176 `�� DATE ISSUFDa 03/09/90
SITE' ADDRESS. . . - 1.3274 SW TOLAND ST PARCE.La 2S1 *Ab- 1164
SUPDIVISION. . . . s 11ORNINOHILL ZONINGr
NL_OCY%. . . . . . . . . . a LOT. * . . . . . . . . . . . 1145
CLASS OF WORK. :NEW
TYPE OF USE. . . eSF
OCCUPANCY ORP. sR3
OCCUPANCY LOADS
TTNA+NT NAME. . . c
Pe!mar-kss •15 for red line copy
Owners
DAN E:: ANDERSON
9363 SW BEAVERTON-HILLSDALE~
N HWY.
BEAVERTON OR 00000 -0000
Phone 141 000--000-000M
Contractors ----_____.___.____________._.____ I �
E). E. ANDERSON INC
8363 SW BEAVERTON HIGHWAY 1
BEAVERTON OR 97005
Phonee No 297-7666
Req N. . a 46344
Occupancy of they A60Ve referenced building is hereby given, and cortifieA
the compliance with the Stater Of Oregon Specialty Codes for the group,
occupancy, and uue" Under which the referenced permit wa16 imfisued.
FIRE DEPARTMENTUALDING IN
BUILDI -e OFFI
POST IN CONSPICUOUS PL.ACF
I
_._
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175 ,��
Type of Inspection
Date Requested -
� �.�r Time__. A.M. P.M.
Address _� 3c� 7y <- Permit
Owner _ Lot #
Builder
The following Building Code deficiencies are require) to he corrected:
Presented to Approved
Inspector U Disapprojed
e7 i
Date
CALL FOR REINSPECTION
❑ YES ❑ AVO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested Time A.M. P.MI�
Address ------ Permit # �3 _
Owner ._ _ __ Lot #_ _
Builder �� —~--
/The following Building Code deficiencies are required to be corrected:
1 ) T77
��� � Cyt,
dd
Presented to ❑ Approved
Inspector ❑ oiapproved
Date
CALL FOR REINSPECTION
❑ YES 13 No
l
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested— - Ti P.m
Address � 7y •F- Permit #_
Owner -- - - I-ot #
Builder
The following Building Code deficiencies are required to be corrected:
1
f`rewnted to j roved
Inspector -- -- C� Disapproved
Gate --- - — — --
CALL FOR REINSPF,CTION
U YES L"I NO
i
I
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection - -- �— � —
Date Requested // - Time--K- A.M._ P.M.
Address43d 2yfz Permit9157
#
Owner !_ Lot #
Builder
The following Building Code deficiencies are required to be corrected:
Presented to _� _ Approved
Inspec-tor F-1 Disapproved
NO
CALL FOR RF.INSPFCTION
❑ YES 0 NO
I
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-417}5
Type of Inspection `-�4 , L
Date Requested_ L� Time A.M.— P.M.
Address _-_I .ki
Permit #
Owner
--- _ Lot # ,
Builder
The following Building Code deficiencies are required to be corrected:
I' —,—s.�r:t�t� moi: J'_i v�L„� -�-=—_L-�`,' ✓� {
Presented to -y _ ❑ Approved
Inspector t.T__..�� _ DIUpproved
DateCALL FOR FOR REINSPECTION
YEI ❑ NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type oaf inspectio-i
Date Requested �_/�� - �S _ me _A.M._ P.M.
Address _ c� %_ Permit
Owner Lat #_
Builder
The following Building Code deficiencies are requirad to be corrected:
ZI
00
Presented to
��� ❑ Approved
Inspector ' Disapproved
Date
CALL FOR, REINSPECTION
Lel YES 0 No
`NISPECTION NOTICE
City of Tigt„d Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
n
Type of 'nspection _.?..� -----
gate Roque >d
_L11 -- Time A.M. P.M.
;%ddress
/ 3 ?L/ Permit
Lot # --
Owner
Builder
—
The following Building Code deficiencies are required to be corrected:
19__-_
_ ❑ Approved
Presented to
_��- _ Qisapp►oved
Inspector _
Date -
CALL FOR REINSPA"TION
ff'T'YES EJ NO
II
I
INSPECTION NOTICE
City of Tigard 3uilding Department '
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-41775 `
Type of Inspection
Date Requested_ =A3 d Time Y,— A.m.--P.M.
Address_ �_ ��__ Ti r -artL��— Permit 10! fI
Owner_ _ Lot # I
Builder
The
(following Building Code deficiencies are required to be corrected: I
� L
1747.1.�.e►. '' 4 ..
r '~ �
Presented to Approved i
Inspector �/ '�1 _ [J Dipwov `
Date
CALL FOR REINSPECTION
El YE>s ❑ NO
i
i
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone:
hon[e: 639-4175
Type of Inspection
Dato RequestedLG S Time A.M, P.M,
Address �-
�_ Permit /.2 5
Owner Lot #
Builder
The following Building Code deficiencies are requirer+ to be corrected:
---
------------------
Presented to -Approved
— __-
Inspector
--�'� --- - - - _-- --_---- U Disapproved
Gate
CALL F OR RENSPECTION
0 YES 1=1 NO
INSPECTION NOTICE
City of Tigard Building Department
P.O Box 2W97
Tigard, Oregon 97223
Phone: 639-4175
/r
Type of Inspection __ �( s4– (�•C t yA 6
Date Requested —Z` -'� Time. A.M. P.M.
Address -_ _ Permit # _
Owner ? __ _ Lot
Builder
The following Building Code defieieneiee are required to be corrected:
Presented to ❑ Approved
Inspector -9irsaQryioved
Date
CALL FOR REINSPECTION
❑ YES 0 NO
INSPECTION NOTICE
City of Tigard Building Department
P.O Box 23397
Tig31d, Oregon 97223
Phone.639-4175
Type of Inspection -------- -
Date Requested_ Tirno ._ A.M._ P.M.
Address ___. Permit
Owner Lot
--
guilder ----- �—
The following Building Code deficiencies are required to be corrected:
Presented to __ LI
!nspector Ll Disapproved
Date
CALL FOR REINSPECTION
❑ YES ❑ NO
CITY OF TIGA RD
SEWEP PF..'AMIT
&4-1 P IK*AM T I NO Sk1391.4169
CITYOFTIFARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 S.W.Hall Blvd..P.O.Box 23397,Tigard,Oregon 97223,15031639-4175 DA'TE 15 5i UEi:I:) EJ/22/09
04'T' $49 3.AIR.'i
J-3,A-7q
,J0114 ADE)WEESS SW 1(31 4IND 13'T U'3(-) NUMBER' 39038
I Ax MAP/1-01, 251 1AD 11.0.100 GIA.-I : MOPNIN(.�A-Ifl I LT' : 145 8K
LAND WiL : fill . 11'.i
1-01' SIZE:
5ECI-TON : 'TUP . PNG: '.Lw
WOPK CLAS0:i : NEW
UGE' TY FIE. : Ili I N(;I..,Il: F'AM'.I.'l Y
The agroer, to (,ninI:)J.y with F11] rLl1E!!;i U11(.1 r'egLlJ.ati0l'l!f; Of t110
TI.1Es prarinit. *-ft x p J.r o s; 1130 (J a y% -F r ci in t h o (I in,t*71 J !i%;i-t (I 'T h ve t cl t a]
amourit paicl will 1-.)e if the periniv. expirt.4!ii . The Acl*-.!n(�y dcici�!-i ricit
alltOIFI thr•-% RC.C.!UrffLCY (3-P t;iie loczatioii of th*e i36-twtar I-F tho� isowor .0i
I-lot F.I.A. they me-atsi.ireiviont givc-ri , thce iriffiti;.O.J.er v;hatl] 3 fe-iot iii
11 dJ.r*-cz1J.civi% from the diiataiicc4 g:i.ve.ii . I-P not iz;o Icic,ate-cl , tho irisstialler
Urchaiiie? iii "To.p iiLrlcl 5J.(JP tiewv-)r" E etr m.l t, oitcl the Agerioy wit'l. iriwtial]. FL Ifittorial. -
1IMPE.PVTOUS AREA :
INSTALL . 'rypi*--- : BUTI-I)TNGo (:iFW1i.*.k 'TENAN'T TMr*,POVF*' ,V'1FIXTURE UNITS :
DWELLING UNITS : 1.
NO . OF DLOGS . . I
0 DE'A
w ANSON DAN E 1-Ill---�MI T $35 . 00
51:3(5;3 N !7.W 8..F:'0Vt--P-TON-HIl L-.DALF; C(INNECTION GHARGPE. $1. ,250 . 0()
F.
R [)eiavertoo u r I.JNE TAP TINSTAI L.
N ANDEPFON DAN V
T M[!'ADOWHIAJO1< UEVEL01:)MEN1
R
A 9363 lid
El
C beeLvertai-I or 9*7006
T
0 PHONE (503) e97--'7666
R I RIEG-TSTDATION NO. 416341-14 TOTAL: $1 ,285 , 00
RECEIPT NO.
This permit is Issued subject to the regulations containod in Title 14
of the TMC. State of Oregon Specialty Codes. zoning regulations
and all other applicable codes and ordinances, and It is hereby PEQUIRED IN5PECTIONS
agreed that the work will be done In accordance with the plans and ROMA I---IN
specifications and in compliance with all applicable codes and
ordinances The issuance of this permit does not waive restrictive
covenants. Contractor and subcontractors shall have current city
business tax permits This permit will expire and become null and
void if work is nct started within 180 days.or if work Is suspended or
abandoned for a period of 180 days any time after work has
commenced It shall be the responsibility of the permittee to assure
all required inspeG"ns�e requested and a oved.
Permittee Signature
Issued By t--rv! t 1-1111"t--.1 N-1115110-11., I (IN 639. M--
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
CITY OF TIFA RD PLUMBINC; PE:PM IT
�-'x 0, PERMIT NO. : pl.-891.4%67
CITYOFTWAVD
COMMUNITY DEVELOPMENT DEPARTMENT 011100N DATE ISSUED: 8/22/89
13125 S.W.Hall Blvd.,P 0 Box 23397,Tigard.Oregon 97223.(503)639-4175 8(i'1 AP5
,.JOB AI)DRESS SW T01 AND S'T
TAX MAP/1-01' 2SI. ZJAH �il-lb - MORNINCA-11.1-1 LT IdI5 UK
I AND USE. : RA. 5
l--C)T SIZE :
J'TF*M: NO : No
WORK CLASS : Nl;:.W WATEP CLOSET 2 'T PAP
USE TYPE : STNC;L.F� F"AMILY URINAL HKFLOW PPVNTP
L'.(JN57' .TYPE : VN LAVORATC)PY 3 TRAP PRIML14
OCICIJP .GOPP, : P3 *1 ILIB SHOWER 2 GI-4:.:A!5E TPAPS
DI SHWASHE44 I.
(;API-3A(.'-',E DISPOSAL I
NC). STORIES : I WASHING MACHINE I
DWEL.L .UNITS : I I A1JNL)PY 'TRAY DRAIN (DIA
FLOOP DRAIN
SINK t GI;::WFI1 (FT)
WATER HEATER 1 "111OPM/PAIN (F-1
OTHER
141E MAPKS :
Clead contractor number
O ANDEPSON DAN E PERMIT 1111125 . 00
WN 9363 SW DEE
AVPTUN-HILI L
NDAL
E beavertan or FI XT U PE S
5 TATE TAX $6 25
(:I MEA
C
0
N WOL.C.C)TT PLUMBING CONTRS INC .
T
R POI40X8'?2
A Gre5tham OR 9*7030
C
T PHONE. (503) 66'7--1'781
PE.GIS-STWATIUN NO. 23eA7
R TOTAL: $131 .e5
PEC,E I PT NO.
This permit is issued subject to the regulations contained in Title 14
of the TMC. State of Oregon Specialty Codes.zoning regulations 4EQUIRED INSPECTMNS
and all other applicable codes and ordinances, and 11 is hereby
agreed that the work will be done in accordance with the glans and PL E3 UNDEPSLAR
specifications and in compliance with all applicable codes and POST & 13EAM
ordinances The issuance of this permit does not waive restrictiv(' WAT'V-P LINE
covenants. Contractor and subcontractors shall have current city PI...E3 . TOPOUT
business tax permits This permit will expire and become null and RAIN DI1AJ.NS
void if work is not started within 180 days,or If work is suspended or
abandoned for a period of 180 days any time after work has FINAL
commenced. It shall be the responsibility of the permittee to assure
all required sect are requeste nd approved
Permittee Signature
Issued By: INSPECIIIIN &3ST—ter 2Z
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
CITY"OFT11FARD
FilITI n'1 Nr: P IR911 T
cmOFiK�R@ r�W F2MT r Nn RI Ifi91 a �t
COMMUNITY DEVELOPMENT DEPARTMENT nA'T F T c;r,1 Ir*n• R/'P;.,/raw
13125 S.W.Hall Blvd.,P.O.Boa 23397,Tigard,Oregon 97223.(503)6394175
---
'M PM'T' Nn RW 1 dp
13A 7q
MIR AnnPF,;r, • 4M16"It" C;W Tnl ANn r,T
'T'AX MAP/1 n'r PqI 4AR 1 1 Ann 41IR• MFIPN'I'Nt,l-ITI I I T 1 a°s RK
I ANO IIr';F' 04 !1,
I 11'T r;T 7r" UAI I IATTnN 4 R5 .A7A GFTRArKG
FPnNT • PO PFAP N
I.If11gK f".I A,r; • NFW 11WFF'I I I INT'Tt; • 1 I FFT• In RTnHT • 1 M
I I(;r TYIJF • ti1-Nf:l 1" F'AMT'I Y Nn Rr'nnnnMG -4 rXT WAI 1 r.nNC;T
I"rlNr;'T' 'T-YI-IF:' • UN Nn RATHt; Sa N• r; • F W
r.PP PA Pnn'T I'iPFNTNr:r;
r it i Ip I nAn N , F W
TnTAI APP-A 1 Sarre`
N11 ,TnnTFq, • T 1 r;T' • '1 9")"1 nnnF rnNST • (" FTn4- PFT?
I••Ir'Tf,HI' 1 R. PNII• APFA gFPAP7 QATFn -
1<Ac,F'MFN1"7 :'Ann • (Irf*1 10 r;rPAP? nATF'n -
Mr77ANTNF7 RAV%FM I T
ri nnn I nAn all I,AI?At,F A:'{R I:-TPF r*PRICI G'7 AI APM7
1:1 11411 f,PM 1 nF'Trr.T7 YFq
141'-,'A'T' 'T'YPr' (,Ar, Hnr:P A('7:F1;r,7
971 AN rrarr:K RY• r'1 h.
PEMARKS :
11111.5 •Nclr• reel ].:Lres•+ r.�I.)py REISSUE OF* NO.
LAST REISSUE
u
EE�i
W ANDERSON DAN E Ph:RMIT $391 .00
N 9:'56:3 CnW HEAVEPTON-„F•ITL.L SDALE PLAN REV'.I:F:,.W #40 00
E h r T.c311 or FIRE DEPT
R
StiTA'T•E: TAX •19. 15 15
OTHEP 111.9 . 00
C E:VE::LOPMENT CHARGES :
:
n ANL7Ei:RS�(:)N 1)AN E SDC(STORM) •290 . 00
N MF--:A1:)OWBPOOK DE:VE:I...OPME:NT !SDC:( LI T'REET) $600 . 00
R 936:3 SW 8I-.'.AVE PT0N••-H1:1_LS DALE PDC(*1. 1 •290 .00
C bPin.v��rtcirl car 9'7006 PREPAID < 1;90 . 00)
C
T PHONE: (90:3) P97--7666
R REX.-s I ST RATION NO. 46344 TOTAL: $1 ,525. 55
�
RECEIPT NO.
1 his permit is issued subject to the regulations contained In Title 14
of the TMC, State of Oregon Specialty Codes,zoning regulations r �
and all other applicable codes and ordinances, and it Is hereby l-- IJINEf) INSPECTIONS
agreed that the work will be done In accordance with the plans and F"O(.)T ING SEWER
specifications and In compliance with all applicable codes and F''OIJNDA T ION WALL RAIN DRAINS
ordinances The Issuance of this permit does not waive restrictive POST 6, BLAM WATEP LINE
covenants. Contractor and subcontractors shall have current city PLL . UNDERSL.AB CITY APPRCH/SW
I b,:-iness tax permits, This permit will expire and become null and
void if work is not started within 180 days,or It work Is suspended or S,L.Ak3 FINAL
abandoned for a period of 180 days any time after work has PLB. TOPOU T
commenced.It shall be the responsibility of the permitlee to assure FRAMING
all required Inrecti are requested and pproved FIREPI...ACE
GAS LINE:
INSULATION
GYP. BOARD
Permittee Signature
t
Issued By — (. _... F-(:)R -
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
CITY OF T'GA MECHANTCAl PE'�RM IT
. Z
ItD .-T NO. ME11391-160
COMMUNITY DEVELOPMENT DEPARTMENT Comm
13125S.W Hall Blvd.PO Box 23397,Tigard.Oregon 97223.15031639-4175 D AT F.:: I S,SUED C3/22/09
N ff . 110.
JOB ADDAE-:SS : 3!234 SW I()IAND 5T
'TAX MAP/LOT PSI 4AO
SUB: M0l4NTN(.*,l--IJA.1I T : 145 bK :
I AND USE: R4 103
1-01 SIZE :
ITEM : NO: NO
WORK (A-ASS: NEW I--'UANAC'E.* 0,11.001K 1. AIR HANDL-14 <10
USE TYPE : SINGLE FAMILY FURNACE .11.001<4- AIR HANDI 1:4 :1.OK
CONST .TYPE.': VN FI 00P FtJPNA(.-,E. EVAP .COULE'R
CHN711.11P. GPP. : P3 HEATER VENT FAN 3
VENT VENT . SYSTEM
BIJI/COMP <3HP HOOD I
NO. STORIES : I 8LR/COMP INCINEPATOP(DOM
DWELL .UNITS : I 13-30HP INLINE PATOR((,'OM
FUEL TYPE' GAS BI R/C'OMP 30-501-11P PE.PAIP UNITS
MAX . INPUT BLP/COMP 50+HP OTHE:1:4 P-
F IRE. DMPWS-J (.*-,AS P.'I:P.I*N('.1 OITTI-ETS i.
HIGH 1111:41E.SS?
HI-EMAPKS :
imeed c�cjntr-akc!tar, ittimber-
0
W ANDEPSON DAN E. P K'R M 3:1 $10 . 00
E
N o:36.3 sw E)r�:Avr--AFON-HTLI SDAl. F. PLAN REVIEW
$10 . 13
FIXTURES $30 , 50
STATE TAX $2 .03
C
0
N
T FOUR SEASONS HEATING A114 (.',UND
R
A PURti x 664109
Pci�tland 01, 97266
PHONE (50-3) 7-15-5919
IR I PEG'TSTPATION NO. ASP-83 TUTAL : tit
This permit is issued subject to the regulations contained in Title 14 RECEIPT NO.
of the TMC, State of Oregon Specialty Codes.zoning regulations
and all other applicable codes and ordinances, and it Is herebyFEQUIRED INSPECTIONS
agreed that the work will be done in accordance with the plans and GAS LINE
specifications and in compliance with all applicable codes and POST IC BEAM
ordinances. The issuance of this permit does not waive restrictive
covenants Contractor and subcontractors shall have current city l-KIJIGH IN
business tax permits. This permit will expire and become null and F I NAL
void it work is not started within 180 days,or if work is suspended or
abandoned for a period of 180 days anv time after work has
commenced It shall be the responsibility of the permittee to assure
all required i,n�Sfe
requested and
,oroved
Permittee S-gnahitn
Issued By:v/I/% (3W.-t: FOR I J.HN 6,3V-.,qI T-3
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
TWA` RD PLANG1ECK APPLICATION
CITY OF cmorrwxm PLAN GIECK I/
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT H
111TSSw.f/aSkit_P.O.Box 23l9f,T19�V^'4°^9rM•(5Q3Ifi3941?S C DATE ISSUED
O DRESS: v`�7/ Tg S -i AX MAP/LOT �S I- y 14 (j- I LG O
JO
/ --�'"-�- LAND USE: N.
SUgr� _ �µ LOT'
SPECIAL- NOTES
OWNER C7 REISSUE OF:
LAST REISSUE: _
ADDRESS: �� - FLOOD PLAIN/
-�� SENSITIVE LAND:
PHONE: - c "7-- -
APPROVALS R�9UI99O
PLANNING:
CONTRACTOR
ENGINEERING: _
NAME: _ r, i - ---
- FIRE DEPT
ADDRESS: _- OTHER:
ITEMS REQUIRED /
LIST/SUBCONTRACTORS:
ARCI1/ENGINEER BUS TAX:
CALCULATIONS:
NAME: _ --- TRUSS DETAILS:
ADDRESS: -- PARKING PLAN:
--- -
LANDSCAPE PLAN: _
--` - 01-HER:
PHONE: - ---- - --- `-
- - �y
PERMIT ACCT H DESCRIPTION AMOUNT AMOUNT PD. BOL:�OII�
1 , 10--432 00 Building Permit Fees
10--431 00 Plumbing Permit Fees
10--431 01 Mechanical Permit Fees1 '' �'
10-230 O1 State Building Tax (5X)
Building
Plumbing _ f.
10-433 00 Plans Check Fee h1
flu ildirig
Plumbing
Mach /0
30--707 00 Sewer Connection _ -
30-444 00 Sewer Inspection S --�-
51-448 00 Street L1-ystem Dev Charge (SDC) J
57-449 00 Parks Sy5Lem Dev Charge (POC) +�.5y 2 Sly
31-450 (X) Storro Drainage Syst Dev Chrg
10-2;10 09 TRFO -
10-731; OG Washington County Fire H1 (9`.,X)
10170 00 Amar /Wedgewoody
alto
R1C 11 ��' l
APPLICANT ICANT SIGIUATURE
Received By: - Date Received:
cn/3587P/18P
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