16692 SW JORDAN WAY Y'I x 'r��iFWYIM'yq/IMn ,,yt�,,y0"W.+�.pr+.�. ,��•r ,�� �,y: '�WIMp�M�tl�' +I M4��
i � i i - Y'• ��'.. n i r r�`IIS t1 �'ry� I��� � ' � �'� ',7. �r, p,� '►i' "L ��� �. �� .{�.. iii
j;at.yd
f f
9 J!
i
r•
'gyp;
h+
�+I
i
1,
d
/
r
I'.
i1
t
.y
it
f
��1ry is,. _,.�`1 • d
.1 'A;�� `..�`�t..ice ••��•ll� A �
M \ j
• YM,Mi..Mui»Y.w4w„+.,..tu..w,r•Mrr�rM�imote6aw.rs:...........:.am..:..,.n..J......i„+..«.«a;epitf' ' ' t�
CERTIFICATE OF
OCCUPANIC
PERMIT T. . . . . . . ..,17YF TIGA"r%
MST93 -04W"
COMMUNITY DEVELOPMENT DEPARIMENT DATE ISSUEDs 03/16/94
J
13125 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)939-4171
PARCi L.s _SIIf. D
!alTr-: ADDf EEG. . ,. 1.6W),_2.. SW -10111440 W r
SUF3D I V I S I ON. , s BEDFORD ULEN7.UNiNGs
L;I..00M� a____..... LOT. . . . _w�
C�..A 7S OF WOrRK. o NEW
TYPE OF USE:. . . s SF
']CCUPANCY GRP. s R3
OCCUPANCY LOAD2120 4
1
rENANT NAME. . . o '
R,.amar•kes P►;_m i
Owners
IJEACON HOMES
99500 GW l a5 AVE
i
aEAWNTON OR 97005
Phone #s 524- 1`199
C Coritracto"s -•._..__.......__._._._�_._...._.....___... .._._ .._�.__.
BEACON HOMES
9'n00 !gW i es"FH
BEAVERTON OR 97005
Phone Mill 5' -4-1999
Peg IF. . s 70782-
Or upancy of the above refprericed bi..lildinrl is herwhy given, and certifies
't he compliance with the State Of Oregon Specialty Colles Uor the gru--tp,
ocrupancy, iind usp under which the r•eferenreci F 16it bras i5,�..
r
;/At
NG FBFi�.t Pi.
pfJS'!' IN C17Nf3F'T CUl7llS �'E_AC;E
t
AL
(g
ki
i
jNSPECTIOII NOTICE
City of Tigard Builttiogr Department
13125 BW Ball Blvd. Ti.gvrd, Oregon 97223 �� e
Tnepection Line (Rec-O-Phone)s 639-4J"5 Businear, Pho-459-4171
Inspections
rooting
Plbg. Underelab Mech. Fough-in Appr/S'dwlk
Pcvnd. Plbg. Top Out Cas Line INALs A
Pout/Beam Struct. San. Sewer Framing .t!1C4'P
i t�f?i
Poet/Beam Mech. Rain Drain Lnsulationplu b
_.,
Tt ,r
PYbq. underfloor Water Line Gyp. Bd. -Mach.
Date Re]uasteds Timet _ AN
Address: 4 GOO Peemit fs
Builder:l. �i — '( �
"1
THR FOLLOWING CORRECT.CNS ARM REQ RED
t i
Inspector•__ APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinap.
. .ay.15F,i-•w.Wiil�ew«.we.y,rvnrninr.n.•rr wnpypnyp.rn...
i
INBP,iCTIAN N-OTIC6
City of Tigard Building Departstmmt %
13125 OR Ball Blvd. Tigard, Oregon 97223
Inspection Line (hec-O-Phone)t 639-1175 Busineas Phan s 9-4171
Inspections___
Footing Plb7. Underslab Mach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALi
Post./Beam Struct. dan. Sewer Framing -Bldg.
i -
Post/ream !loch. Rain Drain Insulatkc?n -Plumb.
Pltq. Underfloor Nater Line (GyLp Id -Mich.
Date RaquestedeTimet ��_AN PN
(_^ � ' - JOY Permit #t -
Bu i l(ler t ���� �'ti\ 2 r (Cf �� ■
THE FOLLOWING CORRECTIONS ARE REQUIRED:
_ C71 C At
iZ.�r.,�.. , �:•=,/r.,to�� �%e:,y f_• ,,�
V.
Slf
iP
art(
1nspect3rt. I! --- -- Datet � 'L`,
APPROVED DISAPPROVRD APPROVED BUWRC" TO UKM
Call For. Reinap.
•,I
L _,.
�r
'yi.e..., a sYw..i .•'r•, '. ��,' i. .F.�.. �F %'�'iM�btt'did'"' ,�,MI' 1�.. i .. � _ r I'
a INSPECTION NOTICE
City of Tigard Building Department
131'.S OW Ball Blvd. Tiqard, 'Oregov, 9722
Inspection Lire (Rec-O--Pho t 639-4175 9usiness Phones 639-4171
Inspections V,
looting Plbg. Underslab :[Neth. Rough-in . Appr/Sdwlk
Found. Plbg. Top Out Gas Line
lTNALt
Post/Beam Strutt. Sen. z#ewer framiry.) -Bldg.
Post/Beam Hoch. Rain Drain Insulation ' -Plumb.
Plbg. Underfloor Nater Lina Gyp. Bd. -Hoch.
1,
Data Requastedt_ Tiov t AM .__PN
qS'
ti
-/7Z
Permit h � w
Builders r� `f7` '/�1,� „q:1k •
TB'E FOLLOWING OORRSCTIONS ARE REQUIRED:
Inspectors
--- -'- -- Datet�
DISAPPROVBD `— APPROVRD SU&TR(CT TO ABOVR
`_Call For Reinsp.
.^.1t7 of Tigard 3. dliO in flepartaent •
S
J131253W Hall Blvd. Tigard, Or-Ion 972
' inspection Lina (Rec-O-Phone)t 6.19-4175 Business P 639-4171
Inspection:_
Footing Pibg. Underelab h. Rough-in ,� Appr/Sdwlk
i, found. Plbq_Top Out—�) Gas L1M ` IINALt
Poe'.:/Beam Struct. Sen. Sewer (— /rarL_ nq
Pott/Beam Mech. Rain Drain Inaulation -PI au.
Plbq. Underfloor / Water Line Oyp. Bd. -Meeh.
Date Requestedt / `� Timet AN PM
Addrees: L )�rmi! 1t� �L��Z. ■
i
Builders
TRE TOLLOWINd NS ARE R8
_��crc{" t�'�J f/�C 1`",L7N S /-�.��`c. �J %"/�✓�c �r--/7CyL=
i
Inepetrtort _—__-- Date:�� ��r
DISAPPROVED APPROVED SUBJECT TO ABOVE
—_Call For Reinap.
T., ww
NP
is
i5 '`
mdww
LEC-21----93— TL'_ 12:05 I D:CITY OF K I Nh .:I TY FAX NU:503 639-3771 � it 199 P07 �
KING CIT".
1, r� N 15300 S.W.116th Avenue,King City,Oregon 97224 Pho.ra:N39-1082
} r_OMMUNI:: DEVELOPMENT
APPLICATION FOR BUILDING PErMIT
(Instructions on reverse)
DAT"/ �,�y.3--
1- NAME OF APP ICA.N'T' ►� �' Phone No._ V-72 22 2—
ADDRESS' '
ADDRESS OF PROPOSED IMF'ROVF2�+T`1T r ----
1
2. TYPE OF CHANGE, IMPROVEMENT OR CONSTRUCTION FOR WHICH PERMIT IS REQUESTED. �
DESCRIBE BRIEFLY - ATTACH 'IW14-C_OPIIES OF PLANS OR DRAWINGS OF
Ylf'
PROPOS®
C_ PROJECT:_
AND ADDRESS 0 �Co .^.�
yke3. Rh & S—E
�-, �. r
PHONE NO. y-/ %' L I CENS?I NO. � �5/$
4. NEIGHBORS WHO MAY BE A-T^ ECTED BY 'THIS PROJECT WILL BE: NOTIFIED BY THE CITY. `
5. APPLICANT O HER/HIS SENT IVE MUST PRESENT AT PLAT TNG CCY"9r1IS ION
FETING HELD ON r
REFRESFI TIVES ._ Z�H NO._•
(The nq City Plannio C00o15Si will conaide�'on hose app( .ations nee ved at least fi (5) daps
prior to a Ileeting.)
_—�IGNATURE
APPLICATION RECEIVED BY yu(y �/ ATE177
/•� i _
APPL I C ABLE FEE RECE I V® $_���''(C�(?�_ TOTAL
PLANNING OCWISSION DECISION: Approvecd�_' Deru�_ — 1
CCVDITIONS '1 J
� )
<U,+1� 1 '{- t"�f�4r? � r rYi
Approved ap .lica 'ons are valid for sir months an',p
Signature __ Date_
ei that all persons who ecntriet for work on their residence be
N04E: O e n 9aaeouil s Gaw regnlr �
�rgistered rith the Builders Board which means the contractor is bonded and insured on the jos site.
y For your protection. �e certain your eontrictor is registered by calling City Hall Ph: 635-1082. k
NOTE;: A permit wst also be obtained the City of Tigard Department of r
aymunity Der�
veloprrt yesl No
CITY OF 'IIGARD INSPEG7 AIL-19-ff
The above listed project has been inspected and Approved denied
Date Camtents
Signature
(Bu,i.ediltg LnbP�C.�4'e D4�ct t �efiun auz (1) copy #D K.-i
CD 1-87
r
r"
:1. '.
R
A
j[f6PECTION NOTICE
city or Tigard Building D6partment
1312S BM Ball Blvd. Tigard, Oregon 9722
Inspection Line (Roc-O-Phoni )e 6/39-4175 ,1Business P on -4171
inrpocttone1 i[A. WU> 1 ��/)1.14�11 otL
— —
1
Footing Plbg. Underslab Hoch. Rough-Is Appr/Sdwlk
Found. Plbq. Top Out Gas Line FINALe
Post/Beam Struct. San. Sower Framing --Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Hoch.
Data R,iquested: 1 I i�� _—_—Time' —_.AH _PM
Builders
AddresIIC l V 2 feN D•-V\ P(�e��it�X��t���.
v� 4
TBE ,
d
TOLLOWING CORRECTIONS ARE REQUIRED:
0
11,
i
I - i
4 _
i`
Inspectors --- -•--- Dates / L
_APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
}
1
i
� t
4 �
�§jyCTiGN NOTICE '/��� J l
city of Tigard Building Depercaent
13125 Sw Ball Blvd. Tigard, orogon 97223
Inspection Line (Rec-O-•Phone): 639-4175 Business thone: 639-4171
1•
�. Inspection:_ --
Tooting Plbg. Underelab Hoch. Rough-in AppriSdwlk
aj
' round. Plbg. Top Out Gas Line FINAL:
a Poet/Beem strut (Ban. t,w4O Fr„.ming -Bldg.
Post/Beam Hach. La Drain) Insulatl_on -Plumb.
Plbg. Underfloor stet Lin Gyp. Dd. -Neth,
�� �,
�
Data Requested: - L+ _-� Time: I
Address: I��f ` z. (?� ,1.Q V'•. K1 Permit. is
Builder.: --
TRE
FOIJAYWIJ CORRECTIONS ARE REQUIRED:
�7
....... ...
i
l
1S
Inspentcr:_/IlT .. -- _ _ Deter_
—APPROVID _—�- DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinep.
I
41;j oil
i � I
.;r
r ”�',+,,. ,d a� _' -
I f i ,
via
.,
INSgECTION NOTICE
( City of Tigard Build Lng Dapartsaent ;
13125 SII Ha7.1 Blvd. Tigard, Oregon 97!23
Inspection Line (Rec-O--Phone)s 639-4175 Buniness Phones 634-4171
I nspect loons s `- /1 _
700149 �'�1/' Plbg. Underalab Mach. Rough-in Appr/Sdwlk
� `
Found.>1, Plbg. Top Omit Gas Lina FINALS
Pont/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mach. Rain Drain Insulation _Plug.
Plbg. Underfloor Nater Line Gyp. 9J. -Meeh.
Date Requeatedt I I Times ��s�Z �twM PM i
Addreaas_{'C�^� Permit tsl"�t��`
((��
ll�,.. ..
Builder:ho rn'A f uY1y5
THE FOLLOWING CORRECTIONS ARE REQUIRED:
^V� �F.��� Citi•-^--• -_�V`Q_ c�C�'�Q_ ��l.h��.Q.t!�/��✓�/' w 5
_�7 ' Q_�- ' �_`�� � 1Z1� Q_ _ .�✓� pp r
let-I
j7I U<�
1
Inspectors
Date: J
APPROVEDDISi1PPROVED -____��APPROVHD SUBJECT TO ABOVE
For. Reinap.
..w•w.•....w..uww.ww..n...,r.nw.w.ww.aw.awYPM81VY1f.Wry uM uMn.Na.e'..aa..w,.�.unMMAWN4w:tYWY,t9,N�.Imw.aww,nw.........iw
NyeM�.yyyy,
F F
CIT` OF TIGARD MAS-!"ER PCFM17
COMMUNITY DEVELOPMENT DEP.,..ITMENT PER01l l"
131^b SW Hoji Bin.—)pard,Orapon 97223.8199 (503)839-4171 DA 11: Iia S UED^ t 1 Illi 1/9
�•'r•�ra L. l_.: ~:�1. 1 l�1. . 1; I/C t i3O
.. ! I L.. (-LV.L)Iti::,:a_i. •. .. l.a�t��i�� ':,ii JL.1I:uf;,'� W �
,'JSI)I V I ,I0N, ,. , S-EW"i)RD UL..UN Z f:ittl:I N6:
_.._...__ .._.._... _...,_.__.... ._. _._.._._...... BUILDING _.......
:h/I"apr:l!fr /�f�L YOW f�LL.I NG Ut+!I PATHS.-
� 1 1 �I?rF�a�p/E�:rMrE-.I�l'i". . . . . . : . :
�..F' ;5 L�1'— WOMIS. :N�W BE 1.)R11.6-P f.���11—'IC• .-2 GARAUE. .. . • • . • . . , .440 �.
vr- USE:,. SE F'1....tat: R f"IF2EA5 - HIwG?lJ]:r?IiU c"El Llr•clm ...... ......_,......,
YPE car-- r;ONST. :5-h. F-'IR81. . . . 151'7 f L.EFT. . . .,, ftr RIGHT. :`:� ft
(.:CIJ#-"'rahlt:Y i:3f2r'. :r r:;;1::�r1_ . . :)7_, 4s h f=FiONJ. .,_ J+ f'
1 1�i.r rZ. . : 1 1't.
,r[)RIES. . . , . . : > THIRt). . . . :0 s f
`1 CjHT. . . 4"t J OTAL __.... _ - = 1 7 s f l:iMOKL Dc-rt"c,r1:1 a-, :y
.„CJOR LOAD. . . : :40 Ps f VOLLIF. . . . « 77rti PF?C•K:NG SPACES. . ; I
11,415. . . . . : . . . : .1 FLUC)!:t DRAMS. . . . '.0 k' >C.' ' LCJ(4 p•'rtLIMTRIS. . 1'1.1
_14 VA TURIr%S. . . . . .': 1 I RAPS.
LOUNDRY rr?AYS, . . : 1 r qTC H, DAS l luta« . ., . . ., . :{?I
ail=�"Tp.R CLOSE'rS. , :2 SLW(:::R LINE ( ft ) . :0 URI:::W3E r RAPS. . . . . . . .CC
yrril_IW(l`�lIF'llc,, 1. Wh'11"! R i...IILII: (ft ) , t, 10 111 OTHERtfZt='�. . . . . :IZ)
:aRDt+TGE: ) Iii( 1 RAIN I)ROIN (ft ) . .0 i
011:31-1I INC:) MACH. .: ., : ). r,f-' 1'•vA71',,, DPPi IIVI:;. . : I r
FEU) .. ........ _... ___.._.....
rC:.l.. 'T YT'F' ;_..._...... __...__... .... U1\1I T Hl R2. . :Ill type amokint icy date .._
VENTS; ., . , . . :171 SPR.T $ 36,17. Olt JH 11/01 /93
Ox INPUT..0 L'1.L.1 V F N I F ANI.J. . e 3' FAP'LE 1, 228. 5Cj •JLH W)/Q.11
.JrRN i 10,0K r )-1001):3. . . . . . .. 1 0`jPc $ 18. 35 ,JH 11/01/93
JRN }-1)70K . , :0 WUCJDSYOVr-P. cQ� Mf"'P'T' 'f 40. 50 JH 11/411 /93
-JUR F'URN. . . :0 CLL' DRYERS, 1 MF't..C11 $ 10. 1:3 JH 11/01/93
OIL/CM1' ! ItE a1;1 OTHER tJ1'-1ITS:: I M"!r,C_ $ x. 0:7, JH 11/01/913
GAS OUT'LE:TS: 1 P P R T 1 1;r"iM. 0 JH l 1/01/93 -
�r�F,l... _ ... __,.._ . .... ....... ..: .....: .... ..._....._..•.. .p''w7�'C; $ �. (, a .7F-I 1 i 11'lti.i'').3 ...
NCON HUMES tYIISC 35J. Oil) JH 11101IcQ
,J00 SW l.u:•:,, AVL,
`..fai1-R'r0N OR
F DIMES
_i00 SW 125TH
AVERTi:!N uii CY70171;5
,ior)e ##^ 524-1999
3,7.-
;s
;s permit :s supd subJer't to the reguiatx.ns crrt.aired in the
card Miinic.pal Code, State c` Ure. Specialty COOS and all other F uclt%fo'.ind Ins(.) P.ir-ek-lace Tnssp
nlicable laws. All work wi l i be dare in acce-dance with approved Post/kt e+am St r^i.c t; Cal, Lint? 1 rr,p)
art. This permit will expire 0 r -t started withir 180 Pcist/ke2,m mecttai) Ins _)Iat icon Inst,
:.,s of issuance, or, if wnrk is sup pan 'Be day.. Pln)/+,ndslab lnt;r.) Gyr) Llcjat,d Irit;p
1-?A3.n ,.ji{aj.r) 17,�,f'
:Y1echran'if,a0 intip I.,.irte 1T'Ijfr•)
/ I I(AML) 1•0p C.),_it0pOY•/S3taw1 k In sp
ec.'. ri
���/ih�1!!�Y«'X11'�Ftlw..M'1PItlNA➢71Nf4fl1tAEAfAMwa.H,rwMr..Mw.f..M•r:N tM/XhIHLNIxv/A:vi'a!w.T.........wnnrwenwwr-r.�..,. ........a..a..•,iaCO!0R6 fAIIF� :
1
A 13125 SW Hall Mm& PLNCK/RECI # —_�_• �� � _
C.'frj"t-'Y OF �r IG RD PERMIT 0
COARMIINITY DI.WELOPME.NT DEPARTMENT
Tigard,Orc6«,9i71�
(50')639,4171 DATE ISSUED
JOB ADDRESS: Joh fry u�,4-✓i _ TAX Mf PI A n
SUB: b"j. G to LOT: ZI LAND JSE: —
w, - �-
VALUATION:# 070�
•
OWNER SPECIAL NOTES
NAME: ''{ ,VJ _VO_M�"`� _ REISSUE OF: _
f
ADDRESS: _�4? �y�� I2'F� °' A-� LAST REISSUE: �
FLOOD PLAIN/
PHOMC: ---- — ����- - -- - SENSITIVE LAND: -1--- -
CONTRACTOR APPROVALS REQUIRED
NAME: � �-i, l.�,o�rti-�'��- 1LANNING:
ADDRESS: _ a _ ENG)NECRING:
U i2E DEPT: - ---
PHONE: --- - �'S-1- - ---_._. _ OTHER: -
CONTR. BOARD #: v_ EXP JrTE:
I ITEMS REQUIRED
SUBCONIRACTORS: PLUMB: lJ��_ C�� -. LIST/SUBCONTRACTORS: _
MECH: Y}�L�(-�' �-� --- - BUS TAX:
�k{t£iEAlGI�LEER CALCULATIONS: -_-
4AME: ean�,��.1Ci� . _ TRUSS DETAILS: —_-- __--
ADDRESS: _ LO —1 U_—'pk�. C,(—T�l ',�:V C.e— OTHER:
PROPOSED BLDG. USE: S A--b LA—, ul
COMMENTS: --- — -- __ -- -
A1W ICANT S[GNATURE --
Received By: --_ Date Received:
I
1011
I
PERMIT k ACCT # DESCRIPTION AMOUNT / AMOUNT PD. BAC. DUE
10-4-,2 00 Building permit Fees 34o.?av
10-431 00 Plumbing Permit Fees l 32,�0 /,3z
_ 10-4: 1 01 Mechanical Permit Fees _iln'Se -0•Y,6
2�0� ✓ Z7.ol
10-230 01 State Building Tax (5%) —_
Building 18.35✓
Plumbing (L 3
Mechanical •4 3 '
10-433 OU Plans Check Fee 2.50 • ��•.3�
■
Building 239.55 ,
Plumbing
Mechanical O.l,�
10-230 06 Fire
_ 30 102 00 Sewer Connection
39-444 00 Sewer Iaspection a✓ 35'
5-448-02 Commercial TIF Fees —^
25-448-04 Industrial TIF Fees
25-448-06 Institutional TIF Fres
25-448-03 Office TIF Fees _
2.5-448-01 Residential Traffic Fees
25-448-05 Mass Transit TIF Fees
52-449 00 Parks System Dev Charge (PDC)
31-450 00 Storm Drainage Syst Dev 'Chrg
24-445-01 Water Quality (Fee in lieu of) –
I
24-445-02 Water Quantity (Fee in lieu of)
TOTAL -?�• ZSD oA�
nm/3587P.WPF
1
t
yFMr4Y., e _ rM'7h�1^rvrdw '
e r sf �`ikm',�+, •.,.',' tum f i
;r
i
CI1'Y of- Y'Ios4RD RFck-IPT OF PAYMF NT NO. c93. 561p
CHECK AMOUNTa Ca Ch'�.
NAME a BEACON HOMES CASH AMOUNT n 0. 00
ADDRESS a PAYM(:N'T
9500 SW 1 i-7 5T'H AVE 'aUBT).I'V 191 ON
HEAVF-.RTON OR 9700 5-
(-PURI USE OF Pf-)YMF:IV t' AMOUNI'I' PAID PURPOSE OF PAYMF..,4 f (•)M01.JN'( PAI 1.)
4
BUILDING Pt=:RM -~ ---_ _ 367. 00
PL LMB I Nt"i 1.41-.RbI
MEC:HANIC:AL. PF: 40. 51A ST. BUILD PP'.-.H 01.
I iI..C'1N
(;HECK F•"F. 1. :i; 6FWF:FC I NSI'F-.1..:T 55. NN
t!-:69;.� SW JORDAN WAY
C31_EN L.L0 P1
?
T(')('AL, ►;MCU,N T PAID _ - —> F.ul.;. 63
r
,lir{
te16
r;yw'
I
CITY OF T I GARD RECEIPT OF PAYMF"NT RECE IP�' NO. s9,3,-243739
C'07rR A 'DINT a %b. 00
NAME BEACON HOMES INC GASH AMOUNT a 0. 00
ADI?RF '78 a 1905 NW 169TH PLACE'. PAYMENT DATE
BEAVw RTON, OR SUBDIVISION
97006—
PURPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
,,.lr--LAN CHECK F'E___ 250,..00 PLAN CHECK FF.__ e"'0.~t00
f
h
6y
f
SW JORDAN WY, I..OT ;::I
' '12835 SW JORDAN WY,, LOT
TOTAL AMOUNT PAIL - - --> 500. 00
a.
i 9
� -r
/p'",4AVrld�.
.4.f w 1' ` �w'� ' ,7 ^�r�wR� f�.
SANITA
Ry• D
Mfga��en�x 155 N.First Ave.,Wits 2.10,Nillborci; 17124 S�lRFACE WATEIR
u03 648.4821
f:OWWE V I ON P17.1041T
yll;lt Vvrtt.1TT t0JI1.'._
C `;Ilt: CIfl1'F; 11.q.Ly3 F�.x1 T1�(1r1'llN t1f�'1'f: U�:SO�)R
STkI�C'TIJRE AIIIIRFSS 16692 PR(J,Irr[;1 i ri`3y
TRI IC 11181.1: 2 I1<C.(7 T :*),W JORDAN''Ir1AY, LOT 21 Bl. OCK1
r'l. 1:;1:1NNF:I:'f f.t'1N� PlFW •.� :_:,. 1)1' ff(.1)r�URl! OL EN PHASE '2
rY �
TYPE IN9TAI.LATJ.QN ��.)`j;i I.. �1kF'k:(1 C..QT'C
!.31HO .I-: FAMILY r .k L 71)1. it) AD 25500
Tk :,�r. ,A 716, I MH 1 Ci0';'C.�
t
OWNFR Bf:( UJIN 1111!11113 fl , nJ
(,I111RES5 190"1 �W. 9TiI �1 �^ 1' . 1F,1+9t �f�kv�i�NaF,�1, .F+I iIN'1 11111:F1(1 111
BF..F1Vr'17i ITN' ,.� rFIC � 0"��14•) t�.!" 3�'y 1 ', r ,
PHONE ;ir.'.4- 190, *_p'rY
F 1 XUR E UIJTVAI.ENT IIWF I L..INf� '$ t „ tr:
'rRE f;111VN'1 1 AL
UNT.TS SERVIC!% UNITS 0 ,n UNI 178 SIINTT�.i 1
`! GQNNFCT I(IN FEES
slivo Acr llA'I E:1: Pt:'.k1r-.l.ar,Mr..NT FEES
SEW1::R CC1;M1.�:CTIQN 7.200 ,00 i-lATr7*R 01.1Al.I.TY 186.00
LE1„ C R DTT 180.00:.•
WATF R 1:11JON ITY 100.00
LESS CREUXI 0 ,00::1•
ERC)STON r0NT ROL
INSPECTION 40 , 00
PL(1N r.,l-IL rK 26.00
5Ut3TOTA L. "11.1200 ,00 9 11BTO I'AL t66400
l 1,01(11. 2366, 00
rtPl L. Nr1i1F 1-'f. l'1 s7 K11'f,,n PH11NF. XIX. V._.
AFFILL.IATIQN VP
I';EHARKS PR().JJ J 9;39--FIFnrt1RU C.O.,--N 4,9- 1- 01 1 21.
*24 1.101.11';' NI') t"ll F2 F" 2111txnN CONTPOI.. TNSF'F..CTIOW; REM.11REIl
JI(:,NA'I'UR � . . 4 _.. r.t',�il.Ir:.)1 )'IY LIIO1if'1:iC1NJl1
i
Permit Conditions: The applicant agrees to oorroy with all rules and regulations of the Unified Sewerage Agency. When calling for an inspection, Please
refer to the Permit Number. The Permit api se one hundred eighty(190)days from the date of Issuance. The Agency does not guarantee the accuracy
of the location of side sewer laterals.
7/93 WHITE — USA, BLUE — Accounting, oR?EN —Inspection, YELLOW — Customer
.
{
1
n