10420 SW KENT STREET-1 r
o.
1
r
1
r
1y�kQ.r r
+ erg
r
y
4
INSPECTION NOTICE
City of Tigard Building Depai:'tsnnt
13125 SW Ball Blvd. Tigard, Orexlon 97223
Inspection Line !aec-O-Phone): 639-4175 Business Phon 4171
Inspection: 1
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Can Line r FINALS
PoeijBeam Struct. San. Sewer Framing ---Rld .
Post/Beam Hoch. Rain Drain Insulation SP1 I
Plbg. Underfloor Nater Line Gyp. Bd.
Date Requested: �`` 9 el -Times ___—_AM PM �.
Address._(f v l�C Permit 1I:,C/
e l/ j ■
Builder. &0011E .IVF lI�..�.. /��C/
THN FOLLOWING: CORRECTIONS ARE REQUIRED:
Insper.tor:.---- - ---� --- Date:
_AAPPROVED —= DISAPPROVED ITPROVED SUBJECT To ABOVE
—Call For Reinsp.
l�� I
u �
lip,
P
?;SpE_CTION NOTICE
City of Tigard Building Departsent
13125 SN Hall Div-d- Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Bueineee Phone: 639-4171
,7 i
Inspection:__ -� --
Footing Plbg. Underslab Mech. Rough-in A Pl'r/Sdw'lk
Found.
Plbg Top Out Can Line FINAL:
-Bldg.
Poet/Beam Struct. San. Sewer Framing
insulation
-Pl:un '•
Poet/Roam mech. Rain Drain In_
Plbg. Underfloor Water Line ( GYP• ad.) -Koch.
Time: AH PM
Date Request ed: /
Permit
t:�LzPermit ■
Address:
Builder:-
THE FOLL4DWING CORRECTIONS ARE REQU7.2ED:
t SCh,
a4
-- 11 �4-
Date: 5
- -APPROVED - ..__ DJSAPPROVE[i APPROVED SUBJECT TO ABOVE
Call For Reinup,
. ..... NO
uef� 1, d 5 I
114SPECTION NOTIC?
City of Tigard Bnildio9 DeV t t
13125 BW Ball Blvd. Tigard, OL®gon 97223 ` r
Inspection Line (Rec-O-phone): 639-4175 Busi,ass Ph:,ne: 639-4171
v
Inspection:
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Pound. Plbg. Top Out Cas Line
FINAL: .
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rein Drair
Ineulntian _P1umb.
Plbg. Underfloor Water line
Cyp�Bd.
-Mach.
Date Requested:
Timme�:� AM „q
Address:1�y� f 1c�,7� Peal
Builder: Psj'i
TNR FOLLOWING CORRECTIONS ARE REQUIRED:
1
Inspector:
Datel
_APPROVED
—APPR- DISAPPR04RD APPRVvED SUBJECT TO AH11VE
___.Call For Reinsp.
I
1 ,LNSPECTION NOTICi:
city of Tigard Bullding Department
1.3325 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O--Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Underelab Hoch. Rough-in iAppr./Sdwlk
Found. Plbg. '"op Out Cas Line FINAL:
Post/Beam Struc:. San. Sever Framing -Bldg. I
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Line C`Gyp. Bd. -Hoch,
Date Requeeted: �J �L� `�/� Time: AM PH
/)l
5
Address:____, C _:PLJ Permit is}� �� ■
Builder: C << /'Vo 2.4 S 31 ✓ C_.
THE FOLLOWING CORRECTIONS A14 REQUIRED:
InnPe r.tor• Date.
APPROVED ✓ DISAPPROVED APPROVED SUMTECT To ABOVE
✓ Call For Reinep.
II
a'rs
INSPECTION NOTICE, y'l
City of Tigard Building Department f /
1.3125 Bel Ball Blvd. Tigard, Oregon 97223"
"
Inspection Line (Rec-O-Phone)s 639-4175 Business Phoria: 639'43.71 j
Inspection: f ,
Footing Plbg. Underelab Mach. Rough-in Appr/Sdwlk
Found. P`.bg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer ( framing 1` -Bldg. ,
Post/Beam Hoch. Rain Drain Insulation -Plumb.
P1bg. Underfloor Water Line Gyp. Rd. _Mach.
Date Re ` IZ _
q:sated:_ Tlme: AM _PN
Address: Permimit `�
Bullder: � cj
, �C`'J S! ( �.L��C�_r1�7 C! � �i ■
THE FOLLOWING CORRECTIONS ARE REQUIRED:
3
a
Inspectors Date:
PPRRVED DLSAPPROVSD APPROVED SUBJ ABq
—Call For. Reinap.
t
k'
� ��;r �� ,#� rt �I��• i �'k��t4x Y � rid �IS3 el,�i' .a., :'I`j� �.,
t
.1
. wrYYm:.r,.n yt n.• •
MEC:f Il1N I CAL
CITY OF TIGARD P1=_RM .
I�'ERMIT #. . . . , , . : MEC94•-0111
COMMUNITY DEVELOPMENT DEP'XR` MINT DATE ISSUED: 05/05/94
13125 SW Hall Blvd.Tigard,Oregon 97223.8199 (509)639.4171
PARCEL: 2S 1 14BP--14100
SITE ADDRE". a. . . : 104L`0 SW KEN) ST
SURD I�I S I ON. . . , SWANSONS GLEN NO. c? ZONING: R-12 /
BLOCK. r . . . . . . . . . . . . . . . . . . . . . .
., LO.1. r
CLASS OF WORK. . :NEW FLOOR FURN. . . . : CVAP COOLERS:
TYPE OF USE. . . . :SF UNIT HEATERS. . : VENT FANS. . . : 1
OCCUIDAI°ICY CiRP. :R;3 VENTS W/O Al='F''L : VENT SYSTEIrIS
STORIE:S. . . . , . . . : 2 BOILERS/COMPRESSORS HOODS. . . . . . . .
FUEL TYPES------- 0.__3 HP. ,. . . . DOIrIF=S. I IVC I N:
:/GAS/ 1 / 3-15 HP. . . . : COMML. INCIN: ■
IIIA X I NF'UT r, BTU 15-30 HP. . . . : REPAIR UNITS:
FIRE DAMPi::R57. . : 30-50 HP. . . . : WOODSTOVES. . :
GAS PRE:SF,URE. . , e 50+ HP. . . . : CLO DRYERS. . :
■
NO. OF' UNITS- - ---- - -- AIR HANDLING UNITS OTHER UNITS. -.
TURN ( 11710K BTU. ( 10000 cfm : GAS OUT•LETS. : 1
FURN ) -100K BTU: > 10000 cfm:
fie inarl(5 : INSTALLING GAS RANGE
OwnNr• -.___..__.._..._ .....______._..__._._._.__.___._____,_______ _ FEES
type aino1_rnt by date
i 04ii LO SW KENT I.)RMT $ 25. 00 BLT 05/0'''5"/94
TIGARD OR 97224.4 5PCT $ 1. 25 BLT 05/05/94
Phone #:
Contractor, : i-
SUIV GLOW, IIVC.
2428 SE 1-05TH AVE.
I
PORTLAND OR 97216
Phone #: 775-41.84 $ 26, 25 TOTAL
Reg #. . .- 481:31 F`
REQUIRED INSPECTIONS -_----.._
This permit is issued subject to the regulations contained in the Final Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other -
applicable laws, All work will be done in accordance with
approved plans. This, permit will expire iF work is not started
within 18@ days of issuance, or if work is suspended for more - � — ~'-- � -
than 180 days. -_�_'_" —._.. _--------- -•---•-----•
IN
P e r m i t t e e SJ n e t
I s s U e(d B yr
Call for^ irlspertion - 6.39-4175
r.
•:its'YI"e {�PVII `f I� r,, _ ''., .. ......n.... 'A,r,.•:..,r..,••nYrFd.Y•r-
1e.,py�r
�Ntll14KtIlY�MtlttNt�} 9M9{A;:NNf�i9�dA1071rWYe'•Irxm¢sRauestw*ae.maR%riim. .., ., wsN
City of Tigard MECHANICAL PERMIT Planck/Rec. #
•13125 SW Hall Blvd. APPLICATION r'ermit #
PO Box 23397
Tigard, OR 97223
(503) 639-4171
—^ esc,iption
Tabls 3A Mechanical Code OTY PRICE AMT
Job 1) Permit Fee -0- -0- 10.00 I
Address C#yswu NP
C 2) Supplemental Permit 3.00
••• Furnace to 100,000 BTJ '
1) incl.ducts&vents 6.00 E
.",g A'.. urnace 100,000 BTU+
Owner 2; h_;.o,cts&vents 7.50 w
3) incl. vent 6.00
—1.—^1 ix—_—I Suspendedseater,wall seater
4) or floor mounted heater 6.00
Fj.hv •'• «" — Vent riot incl. in
Occupant 5) appliance permit 3.00 t
' �^Y'�°'•'• Repair of heating,fe ng.
i 6) cooling,absorption unit 6.00
•_ or er or comp, heat pump,air con .
7) to 3 HP absorp unit to 100K BTU 6.00
••c < 7\ c`rt Boiler or comp, eat pump,ai,
Contractor ` �-� `1 8) 3"15 HP absorp unit to 500✓ 01U 11.00 I`
'•'• , u
Boiler or cornp, twatt pw p,air con .
9) 1530 HP absorp unit.5"1 mil BTU 15.00
SIA1. •r•••"^N. coy B. T. '. Boiler or romp,heat pump,atr con .
i � 10) 30-50 HP absorp unit 1-1.75 mil BTU 22.50
hereby ac now a ge that I have ren tis app:cation,that t he —�oiTer or comp heat purnp,air cores.
information given is correct,that I am the owner or authorized agent 11) >50 H`1 absorp unit 1.75 mil BTU 31.50 f
of the owner,that plans submitted are in compliance with State Air handling uniting unit to
laws,that I am registered with the Construction Contractor's Board, 12) 10,000 CFM 4.50 1
that the number given is correct, (If exempt from State registration, Air handling unit i
please give reason below.) 13) 10,000 CTM 4 7.50
Non portable
CL, 14) evaporate cooler 4.50
Vent tan connected
15) to a single duct 3.00 I
Ventilation system riot
16) included in appliance permit 4.50
., rur•°wrw nr ywri 11° Hood Servet by I
t 7) mechanical exhaust 4.50 j
escri a work new C) addition 0 alteration 0,1repair Commercial or industrial
to be done residential C7 non-residential O 18) type incinerator 30.00
Existing use of Other re.,woodstove,water —
building or property 19) heater,solar, clothes dryers,etc. 4.50
-- —
Proposed use of 20) Gas piping one to four outlets 2.00 1 l
building or property _
Type of fuel -oil natural i a. LPG 21) More than 4 per outlet
yp C� J of Q electric��
O ICE —
Mininium Fee$25.00 SUBTOTAL ,Ob
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 70
AUTHORIZED IP NOT COMMENCED WITHIN 180 DAYS,OR 5%SURCHARGE '
IF CONSTRUCT;ON OR WORK IS SUSPENDED OR — -- —
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIMF PLAN REVIEW 25%OF SUBTOTAL.
AFTER,WORK'S COMAAENCFD —
TOTAL
Special Conditions —�—
Da10 issued by--- --_—
WMECeP1.1l
•m1`tmM•r
t FI'"a1ilA✓�r�,1
,
r
s�
�a
;..r..r•�..nw��e.2..�,meam umao�'«+.W.., .-.�._., .....�...»,.�,..-....»r.... � � ..,.Ly... :__.._.,�..__+.---•�_,.,.ar.,..w...«<.. .-.. _......_._......_..._s�....�.-�..�.�
r ' M
CITY OF T I OARD FtE( F::I1=''1 (:1F- 1"'FIYMF M•T REC CU'l F''f MCI, n'��+ i,'"i�,C�°"+(�
CHECK AMOLIM•1' n 26. 25 �
to{M : tt fi:1M(3E..C)W, :CMC CA`1.4 A11C)UM'T n 0. 00
DDT�F::fi�, n
2428 SE IP)5'TH PAYMF::NT DATE:' a Ct15/05/94
PORTLAND, OR :iUI�I)IV'51014 n
972 16
•'URF•'OSE OF PF•IYVIF;:NT AMOUNT PAID PLJRPO' or' PAYMENT AMOUNT PAID
.................. ._.___....,,......_.»__,..._. ... ......_......... __...._..» _......_....
UTI...1)1NG PF,.R1i MF:C*94•--MlI.1 i76.p5
i,
04PO 8W KEN I*
ITUTOL AMOUNT I'-',AID ._ ... ....7 r'E:',.r';'i j
A
S`
i
t�
k
INSPECTION NOTICE r
City of Tigard Building Department (§
13125 SW Hall Blvd. Tigard, Oregon 97223
Inspection Liae (Rec-O-Phone): 639-4' 15 Bueinene Phone: 639-4171
Inspection:
Footing Pl.bq. Underslab W�Framinq ��
Appr/Sdwlk
Found. I
Plbq. Top Out asFINAL:
Post/Beam Struct. San. Sewer -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Ply_ ,
Pl.bg. Underfloor Water Line Gyp. Bd. -Mech.
Date Requested: 5'-57- f -y
-- —Time: AN M �
Address: Permit 1:_ —
Builders . C�L! CJ �-�,-•y 1C'/ � �S/ 6- f. � �C�<�r' � � "
THE FOLLOWING CORRRCTIUNS ARE REQUIRED: -----�
Inspector: �. ��.._ �____-. -----•--_---_�_--
Date
—APPROVED D1.3AFPROVFD —_V ApppOVED SUBJECT TO ABOVE
` '//////���✓��' call For Reinep. P
NSPECTION NOTICE I
City of Tigard Building Department
13125 Sit Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:__
Footing Plbg. Underslab Hech. RougF .in Appr/Sdwlk
Found Plbg. Top Out Gas Line FINAL: I
Post/Beam Struct. San. Sewer Framing -Bldg. 9
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Hoch. .
� C
Date Requested: // s J. y _yTT1m�e-:� /1— AM ___PM
Address: 0C/�o/ /7 i — Pq/erNmi/t 1. (J a/
_Ls
Builder. [' / - P.S 51✓e( G (��Jr .�-�J _ ■
THE FOLLOWING CO CTIONS ARE RREEQUIRED:
Ii
Inspects: :_ ---_ —__ —Y --- -- Date:_ Z_7 �/ y
\ `1
PF ROVED DISAPPROVED — APPROVED SUBJECT TO ABOVE /
-Ca I I For Rei.nap.
r
J
INSPECTION NOPICL V
City of Tigard Building Departmernt
3.3125 ON Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-•4171
Inspactiop:L
V
Plby. Undersiah Mech. Rough-in Appr/Sdwlk
sand. i' P3.bg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Hoch.
Date Requeatee: _T'-me�: AH PH
Address:
Builder: fi H`re_,6S V e — — O��/to -
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Date:_!> » y
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
__—_Call For Reinsp.
r .�J
tot, d i t atv 4
' .. ..... ._. ....a?., ✓Pi'Wi fe( .ir . J a _
PLUMBING PERMIT n
• CITE' OF TIGARD DATE1 ISSUED: w 04/14/944-01C'E
COMMUNITY DEVELOPMENT DEPARTMENT `
13128 SW Hall Blvd.Tlpard,Orapon 97223.8199 (503)830-4171 PARCEL: 251 14BB--14100
SI'TF FIDDRESS._, . . 10420 SW I;F IIT S•T
SUBDIVISION. . . . : SWANSONS GLEN NO. ` ZONING: R--12
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :82 F 1
CLASS OF WORK. . :ADD CARBAOE DISPOSALS. . :0
f'YPE. OF USE. . . . :SF WASHING MACH. . . . . . . :0 BACKFLO' l PREVN'TRS. . :0 ,
OCCUPANCY GRP. . : R3 FLOOR DRAINS. . . . . . . :0 TRAf'ci. . . . . . . . . . . . . . :'D
STORIES. . . . . . . . .2 WATER HEAT"I. . . . . :0 CATCH BASINS. . . . . . . :IZ►
FIXTURES•---.-•----- -- LAUNDRY TRAYS. . . .. . . :0 SF RAIN DRAINS. . . . . . 1.
SINKS. . . . . . :0 GREASE TRAPS. . . . . . . :0 �
l_AVATORIE S. . . . . :0 L.ITHER FIXTURES. . . . . :0 1�
FUB/SHOWERS. . . . , SEWER LINE (ft ) . . . . :0
WATER CLOSETS. . :0 WATER LINE (ft ) . . . . :0
DISHWASHERS. . . :0 RAIN DRAIN (ft ) . . . . :0 v
Remarks . ADDITION (YJ 640 SL! F.T. PATH I
!
OWNER:
JEFF ADEN BP171 $ 193. 00 SW 0/1/14/94 -
1 ZAII SW !;ENT ST BPLC $ 125. 45 JLH 03/22/94 94250374
P 5 P C $ 9. 65 SW 04/1.4/94 -
-f IGARD OF! 97223 MPRT $ .:.7. 0111 SW 04/1.4/94 -
Phone #: 620-7255 MPLC $ 9. 25 SW 04/14/94
M5PC $ 1. 65 SW 04/14/94 -
1=1l1_lmbing Contrar_tore-- -_._-__._.__.___T._.._ PI•='RT $ ; 5. 00 5W 04/1.4/94 - ffff
Namq,& 'Tv !n F�` F C $ 1, 25 SW 04/14/94
VU�TI � �
Address :
City : _ State :
Zip: _ —Ph one
REEUL)IRED INSPECTIONS --__.....__ . ....
This permit: is :.ssued subject to the reg..
ulations contained in the Tigard Municipal Font/found Insp Plumb Final
Code, State of Ore. Specialty Code, and all. Post/.Se'Am struct _ _ _
other applicable laws. All work will be done Poct/IBeam Mechan
in accordance with approved plans. This .•Iechaniral Insp _...__�. _.._..__.._..._............_._ �_
permit will expire if work is not started Framing Insp
within 160 days of issi.Iance, or if wor is Insulation Insp
suspended for more than 160 days. Gyp Board Insp
Rain drain Insp
Mechanical Final
Building Final
Erosion Control
Crawl Drain
At horized P1.1-t Bing Contractor Signature
Call far inspection (. 39-417;
Contractor Nates :
I
..W.
u
+d
;4
t
CITY OF TIGARD 1='ERP9IMAT#... . . . .PERMITIrIST94-0126
COMMUNITY DEVELOPMENT DEPARTP',ENT DATE ISSUED: 04/14/94 �
13125 8W Hall Blvd.Tigard,Oregon 07223.6190 (503)639-4171
PARCEL-, 2S 1 141.38-14100
SITE ADUkE:SC7. . . : i 042_0 SW KENT ST
SUBDIVISION. . „ . : SWANSUNS GLEN NO-2 ZONING: R-12 r
l3UIL1?TNG
REIFSCUE: DWELLING UNITS: 1 B(ISEMENT. . . . . . . . ..0 s
CLASS OF WORK. :ADD BE_DRMS:O PATHS:O GARAGE. . . . . . . . . . :0 sf r
TYPE OF US . . . :S1 FLOOR AREAG----•__.__._______.. REOUIRIND SETBACKS--- -•-.___--_-._
TYPE t_)F CONST, :5N FIRST. . . . :320 s-f LEFT. . :5 ft RIGHT. :5 ft
OCCUPANCY GRP. :R?, SECOND. . . :320 s FRONT. :0 ft 13EAR. . : 18 ft
STORIES. . . . . . . :2 WIRD. . . . :0 s T,EQUIRED----- __._______._----
HEIGHT.. . . . . . . . :.24
_._HEI( HT.. . . . . . . . :._'4 ft TOTAL...-_--- --:640 sf SMraI;E DETECTORS. :
FLOOR LOAD. . . . :40 psf VALUE. . . . . $ : 29440 PARKING SPAC:ES. . :0
Remarks : ADDITION 0F640 SCS FT PATH I
------ -••------_____._._. __.___._____.___ PLUMBING
o,
SINKS. . . . . . . . . . :0 FLOOR DRAINS. . . . :0 BACKFL-OW PREVNTRS. . :O
LAVATORIES. . . . . :0 WATER HEATERS. . . :0 TRAPS. . . . . . . . . . . . . . ..0
'TUB/SHOWERS. . . . :0 LAUNDRY I RCYS. . . :0 CATCH BASINS. . . . . . . :0
WATER CLO;ETS. . :0 SEWER LINE (ft ) . :O GREASE TRAPS. . . . . . :0
DISHWASHERS. . . . :0 WATER I.-TNE. (ft ) . :0 OTHER FIXTURES. . . . . .0
GARBAGE DISP. . . :O RAIN DRAIN (ft ) . :0
WASHING MACH. . . :O SF RAIN DRAINS. . : 1
MECHANICAL -------------------------- FEES
'=UE:L TYPES--.___._-.-.._.._-___ UNIT' I•i7RS. . :+Zl type amo+.rnt by date recpt
r,
GAS/ / / VENTS . . . . . :5 BPRT $ 193. 00 SW 04/14/94 -
MAX INPUT:O BTU VENT FANS. . -,0 BPLC $ 125. 45 JI-.H 03/22/94 94250374
TURN ( 100K . . :0 HOODS. . . . . . : 1 B5PC $ 9. 65 SW 04/14/94 -
FURN ) =100K . . :0 WOODSTOVES. :0 IhPRT $ 37. 00 5W 04/14/94 -
FLOOR FURN. . . . :0 CLO DRYERS. : 0 MPLC $ 9. 25 SW 04/14/94 -
BOIL_/CMF' ( 3HF1:0 OTHER UNITS:O M51DC: 1; 1. 85 SW 1114/ 14/94
GAS OUTLETS:O PPRT $ 25. 00 SW 04/14/94 -
Jwner: ____..-.-__.__._. _ _.._____.__-___....___..__.___._._.._.._......._....._1='5PC $ 1. 25 SW ;)4/14/94 -
JEFF ADEN
1042:0 SW KENT ST
116AND OR 97223
Phone it. 620-7255
Contractor:
PROGRESSIVE BUILOERLS NW
8575 SW BORBUR BLVD
POR.TI.-AND OR 97219-0000
Phone #: 503-246-1950
Req #. . . 35628
$ 402. 45 'TOTAL
This perilit is issued suh)ect to the regulations contained in the - - - --- REUUI TIED INSPECT IONS ---- --
Tigard Municipal Code, State of Ore. Specialty Codes and all other Boot/fo+_lrld Insp Mechanical Final
applicable laws. All work will be done in accordance with approved Post/Beam Str1_tct B+_lilding Final
plans. This rermit will expire if work is not started within 180 Post/Beam Mechan Erosion Control
days of issuance, or if work is suspended for sore than 180 days. Mechanical Insp Crawl Drain
Framing Insp P1+_lmb Finial
I n s i_l l a t i o n Insp
Gyp Hoard Insp
C s s 1.1 ed Py � ._....._�_..._...�_�_...._ Rain drain Insp _
Call for inspection - 639-4175
i
¢dJ�
1 �J
Residential Building Permit Application
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
Jobslte Address:
'DU/M500 GLGI) Lot # �� Office use Only
Subdivision: � I
-`'2 2 V �i( e Planck/Rec# � __.2 7
Valuation: J� � r ■
Owner:
.Reissue of
■
Address: JCg2_0 �l,J K S'f7zC�T _ Map& TL#
T16)1-�&b o2 72-
Phone:
2-Phone:
toZ0-7255 Approvals Required
Planning
Contractor: P20 cb fte 51 WE ►.,`C JLS n w Engineering
Address: 'E sw BZ&jn FLVb Other
02 (:1 7z(q
Phone: J�7
2`}��—I�� - Items R gulred
Subcontractors
Contractor's License # 35(,-Z6
(attach copy of current Oregon license) Truss Details
Subcontractors: Other
Plumbing: AJ14
Mechanical: P, ►SUi V
(attach copf current OR Contractor's License)
Architect/Engineer:_S'Pniz u-
Address:
Phone:
COMMENTS:
.lip 24
Applicant Signature & Phom number
Received by: Date Received: ���
Permit # Account Description Amount Amt. Pd. Bal. Due
Bldg. Permit (BUILD)
Plumb. Permit (PLUMB) S`'--, 2 S'o LVI
■
Mech. Permit (MECH) 7 1'0
State Tax (TAX) _Z,?, 7a � ■
Bldg: 1• ��5� V
Plumb: . L �,_✓' •
Mech:
Plan Check (PLANCK) w,/ � y
Bldg: / >, >✓�
Plumb:
Mech: 1 z> .
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP) _
Parks Dev Charge (PKSDC)
Storm Drainage Chg (SDSDC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
Commercial TIF (TIF-C) _
IndustriatTIF (TIF-11)
Institutional TIF (TIF-IS)
Office TIF (TIF-0)
Water Quality (WOUAL)
i
l
Water Quantity (WOUANT)
Fire District (FIRE)
I
TOTALS: ` 6� J� Z ' �!'7 2
I
� I
e
ys.
w
cz
i
E-116 M(:71 (l'h/1lht�IrF
rtA X 141 n D
r L,vd A w,,�m C L.L N
1
LO
IPT
5' o
'
aTd T �• ... 1
qui -c
11TY CIF Nofwx) F:E:(:F. Cf''r OF Pf•IYME::Nr RF.CEi::CE'1 NO. tt94 E253 P83 �
CHECK. AITIOUN I
iAMF a F'r�C'1c�E:F:;i;3T.VE: BUILDERS roc NW CASH WMOON T• u 0.00 �
DDRESS x 85'?S SW x:+flE'+x:UR HLVx) !'faYhlt.P11 x)f1rF: y C 4/:l/+/��i
97219-1.
.:,
-OURPOSE C11- PAYMENTfaMt)1.1N'1 F'fa:l:ri PURPOSE 01,-- r•'wYME;;Nr AV101.1Nr F'fa:r1)
U]:I...DINO PERM Mri'r` 4---GJ1.Pf, :193.PI14 E'I.UMFUMC3 PERM r..,a. W
1.P.
r. PER �7`�
'1F:C1.1WN'CC:faL_ PE :3'7.0(( X3'1 . x:UIL D
':,LAN CHECK E'F 119. 41
11.0420 13W
1
II 1.1TAL. AM('l INJ F,f•171) - —) ;3617. %''i'
a I7Y OF I ) L t11,.I, b;I t. I .I1 1 Ot Pfati'I'II- NI �',II11.:P.1'ttl't1I►li'Il =`'�4 r"il;',��4
t'
I(t141. a tVOtih'r '�C►xVM: +11r1,r)r fc13 t,tl!;li (11•Iltlll,ll 1%1.,00
Il)r)E�F SS c hIC1RTF114P31 1'ti YI''ll.hl! rata!1 � 03/RP/94
!3lik{)!
8oi741i f;w EM1* k:+t11(
IL!l!E{POSE. OF f-IM1,11. h1! t►IhtiL►lI1 1-'t11.Ji II)I,;I,ij'yl:: OF POYMM•.MJ1 w1hYf)IIt4l t•'t{I:U
.I Of t , 111 9b.C. y
I
'I �!'fal.. f)I"1t111111 1'OID .. ; ,),:.i. P.;3
•,� I 1