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CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT PLUMBING PERMIT
13125 SW Hal!Blvd.Tigard,Orogon 97223*8199 (503)839-4171 F,ERMIT # -013'
1.Z135-3 -SMJ PARCEL: 25112198A-HC3002;
CLASS OF WORK— :ADD GARSAGE DISPOSALS. MOBILE 11OMr-.. SPACEG.
WATER CLOSETS. . : WATFR LINE (-Ft ) . . . .
DISHWASHERS). . . . : RAIN DRAIN ( ft ) " . .
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LAKE OGWEGCJ OP 97035 77J 7W
Phone #- 635-9446 �
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Conti-acto
13210 GW BULL MTN RD
TIGARD OR 97223
This permit is issued subject to the regQlations contained in the RP/Backflow Pr,ev
Tigard Miricipal Code, State of Ore, Specialty Codes and all other Final Inspection
applicab:e laws. All work will be done in accordance with
approved plans. This permit will expire if wor� is not started
within 180 days of iisuance, or if work is suspended for more
than 180 days.
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City c),-Tigard PLUMBING PERMIT Pian.wRec. #
13125 sw Hall Blvd. APPLICATION Permit # --o(31
Tigard, OR 97223
(503) 639-4171
-- .
scnp,ion
La fi 2- .39 `> I ORS 814.21.610 QTY PRICE AMT
Job -71 .,�d G GJ 7 22. 3 FIXTURES
Address in
_ Lavatory
I ub or I u ower Comb. —
Shower Only
t afar oset
c / — `
Owner U �>1 0''7 isiwa er —
_ Uarbage ispo
L C�tQ ��7��3 s Washing Machine
For-Urain
ater eater
—�T aun ry m ray
OCClJ�J3nt Urinal
Zip Other Fixtures(Specify) Taff— "
750
` CC/ MISCELLANEOUS
Contractor
�� tLGfi Gil `17 2 ySewer Ist — --
` uny M T-"WO Sewer-ea. — —
�)��2- zr� rWater rvice is 2TM
ere y a ow"effiaFTve read is application, the Water Servire ea. Addit.200' 15.00
information given is correct,that I am the owner or authorized agent of
the owner,that plans submitted are in compliance with Stale laws,that I Storm 8 Rain Drain 1st 100' 30.00
am registered with the Construction Contractor's Board,that the number Storm 3 Rain Drain Addit. IOU' 15.00
givrm is correct (If exempt from State registration, please give reason _
below.) Mobile Home Space 25.00
-- —- c of w F5_F4wentwn
Device or Anti Pollution Device 7.50
n_ rap or Waste Not
Connected t,a Fixture 7.50
sc-nTo work new bt addition U alteration U Catchasstto be done residential p non-residential p -- —
Insp.of Exist. Plu nbing per hr
roSpecially Requosted Inspections per hr
Existing use o — mngle
in ra , si5`mMy
---
building or property dwelling 15.00
Residential ac flow prevention
devices 15.00 S.(�
Proposed use of
building or property-
xcept residential ac ow
prevention devices)
NOTICE '14inimum Fee$25.00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5%SURCHARGE t 1
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF _.
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED PLAN REVIEW 2596 OF SUBTOTAL 5,
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. `--
TOTAL
Special Conditions —' -_ —
-- -- Date issuedf&-.j n - - J b
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