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12390 SW NORTH DAKOTA STREET i *M165 SW NORTH DAKOTA STREET ni% r.Fe-1 j I: I(-,A I E: 0 f m (,W 0W y CITY OF TIGA (Cff Y OF TW�14110 P L R 11 J 1 04. M51,90 01 16 COMMUNITY DEVELOPMENT DEPARTMENT OREW-PH A I� 0 71'1.6/90 13125 SW HWI Blvd. p,0.BaR 23397,TipM,Or"mi 97223(5031619-4176 DA I F ISSUED 1 SITE ADDRESS. . . !j14 NORIH DAKOTA ST 1'.)ARCEL v 151.3 4CEI 851 SUBDIVISION. . . . a ON-ION PARK ZONINGe R-7 BLOCK. . . . . . . . . . n LOT. . . . . . . . . . . . . 113 CLASS OF WORK. IHEW TYPE OF USE. . . v SF OCCUPANCY ORP. :R3 OCCUPANCY LOAD1220 TENANT NAME. . . Owner TRIPLE L CONST. P.O. BOX 361 BANKS OR 97106 Phone #t 324-3851 Cantractoro TRIPLE L CONST'. P.O. BOX 361 BANKS OR 97106 Phrine tie 324- 3051 Reg #. . 1 50084 Occupanvy of the above reverenced building is hereby givvyl, arid certifies the compliai-ire with the State Of Oregon Specialty Codes fear "10 group, occupancy, Arid CISO Under which the referenced permit was tmstivd- LDING INS TOR FIRE DEPARTMENT C sUlaING OFF. IAL POST' IN CONSPICUOUS PLACE /�• INSPECTION NOTICE City of Tiga d Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of inspection _ G Date Requested Time A.M.___-P.M. Address "T�"fa"� / !J.lC Permit Owner �`� Lot # Builder L� ---- -- ------- ----. The following Building Code deficiencies are required to be corrected: Presented to _ — A�iproved Inspector ) Disapproved Date CALL FOR REINSPECTION C] YES ❑ NO i INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 972.23 Phone: 639-4175 Type of Inspection Date Requested Time X, A.M.-_ P.M. Address Permit / Owner _. ��'°_.�_L _�_. — Lot # _.---_-- BuilderThe following Building Code deficiencies are required to be corrected: Al Presented to — - VApproved Inspector d ,, �� �� �� Disapproved Date CALL FOR REINSPECTION ❑ YE& El NO INSPECTION NOTICE --7 City of Tigard Building Dppartrnent P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 ,-7 Type of Inspection -7 Date Requested j o2 Time A.M. P.M. Address '� ' 1 7lei. Permit J Z Owner Lot # Builder The following Building Code deficiencies are required to be corrected: Presented to F! Approved Inspector Disapproved Date CALL FOR REINSPFC'TION YES ONO INSPECTION NOTICE City of Tigard Building Department P.O Box 23397 Tigard, Oregon 97223 P/hone: 639-4175 Type of InspectionIL���t' Date Requested_ JipU Time A.M`- P.M. Address - Permit Owner Y_ � �� _ Lot Builder __--- The following Building Code deficiencies are required to be corrected: Presented to NApproved Inspector r ❑ Diwpproved Date CALL FOR REINSPECTION EYES VkNO � w m 'w "" View continents for selected item OAMASTEP. PERMITAAAAAAAAAAAAAAAAAAAaAaA��A6fi5Afi3�53Afig�A���3Ai�3a�A3da5�S�AAaaAG :MST90-011.6: PROJECT:ANTON PARK : STATUS:I : UPD:06/28/90: :JLH: ° PERMITTEE:TRIPLE L CONST. PRIM. . :MST90-0116: ° SITE ADDRESS:12390 SW NORTH DAKOTA ST OA CASE HISTORY AAAAAAAAAAAAAAAAAAAAAAAAReq/Se►ttASchd/DueAEnd/DoneAAByAStatAAAG A705 Foot/found Inep 04/04/90 GS APP ° A707 Wtr Proofing Esm•t Walls -UO? A*t I0 Posc/Beam Inep 04/19/90 KS PASS ° A713 Crawl Drain A717 PLM/Underfloor 04/17/90 MS PASS ° A713 Ftng Drain Bsm't Walls 8720 Mechanical Inap 07/i.r /f, A722 Plumb Top Out 05/17/90 MS PAS.3 ° A725 Framing Inep 06/14/90 GS NOT ° ° A726 Framing <REINSP> 06/20/90 KS APP ° A730 Fireplace Insp 06/08/90 KS APP A'735 GaG Line Inep 06/28/90 GS APP ° A735 Gas Line Inep 06/28/90 GS PASS A740 Insulation Insp 06/30/90 KS APP ° A745 Gyp Board Inep 06/.30/90 KS APP ° AAaASagAA<'�AA5.A5AAAAA5A5AAAaAAA3AaAA3AAaAAASnAAAAAAAAAAAAAAAA�tAAaaAAA�.A5AbSAAAAi INSPECTION NOTICE City of Tigard Building Department LO P.O. Box 23397 Tigard, Oregon 7223 Phone: 639-411 75 Type of Inspection Date Requested (D d _�7G Time A.M.-P.M. Address PermitD'�//lD. Owner ---�-- Lot Builder The following Building Code deficiencies are required to be corrected: Presented to L _ .., � Approved Inspector Disapproved Date '"" CALL FOR REINSPECTION C7 YES L-1 NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection CA-.— Date Requested -,P& :& Tlme` M. P.M. Address — %.�-�5 5 .__ ��.. T Permit # '�rD Owner _ -_ __- Lot Builder The following Building Code deficiencies are required to be corrected: i Presented to e approved Inspector --- -- - _ < I Disapproved • r, Date CALL FOR RFINrf' MON CI YEs C] NO INSPECTION NOTICE City of Tigard Building Department P O Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection --- Date Requested _ �j d_ _ Time _-_ A.M,—.P.M. Address __--11P A60-,,Z- - -,-- _ Permit Owner _ _.---__-_ Lot # Builder — --�`"=-- -•------ �.,.. - --- - -- --- —The following Buildinq Code deficiencies are required to be corrected: Presenter) to pproved Inspector �- � ❑ Disapproved Date CALL FOR REINSPECTION C] YES F-1 NO ea► � rsv e� v er war � INSPECTION NOTICE �— City of Tigard Building Department P.O. Box 23397 27 Tigard, Oregon 97223 Phone: 639-4175 Type of Inmpection Date Requested Time _ A.M. P.M. Address Permit #,�& _6 Owner -�1','� ..._,_ Lot #t Builder The following Building Code deficiencie are required to be corrected: f s Olt �t Presented to �/.—.—` Ap roved Inspector Disapproved Date CALL FOR REINSPECTION 0 res O No .. .ss e�sl nor s� #s rasis 01W INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Request-cl A.M._ P.M. Address tJ Permit Owner _ _ Lot #_ 3uilder The following Building Code deficiencies are required to be corrected: s Presented to — Approved Inspector _ � � Disapproved Date L ?� CALL FOR REINSPEC77ON ❑ YES ❑ NO s sssa seer s� seer w. nw INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oreqon 97223 Phone: 639-4175 Type of Inspection�s—, ----- ---f- Date Requested r-'J e .M. P.M. Address �_ ermit _ Owner.--- ---- — ----- -- Lot # 1 BuilderThe following Building Code deficiencies are required to be congcted: Presented to _ llpprove.d Inspector Y-- - Disapproved Date. �— CALL FOR REINSPECTION [] YES Cl NO sw ear .er e.r wr ear w e, nr INSPECTION NOTICE ���► City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 -�- Type of Inspection _ Ot J — Date Requesteu �11 me 46M. ._—F.M. Y Address Permit # '�—/ [- 2 .z Owner� VZ�� Lot # - ����rr� Builder The following Building Code deficiencies are required to be corrected:. l 4 Presented to /Approved Inspector _ (_� Disapproved Date CALL FOR REINSPECTION ❑ YES Cl NO ( �I t NNLIW INSPECTION NOTICE City of Tigard Building Department , F'0. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection 7r,7 – Date Requested�- /S I C Address Time--� A.M. _p.M. Owner Permit Builder_ A,lLot------------- # The following Building Code deficiencies are required to be corrected: Presented to -- - ----------�- -- – Inspector *. -ApP►oved Date fC '— _.---- DisaPP►oved CALL FOR REINSPECTION fJ YES a 140 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.M. Address Permit Owner Lot Builder The following Building Code deficiencies are required to be corrected: '44 Presented to Approved Inspector Disapproved Date CALL FOR REINSPECTION F 1 YES L NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested Ife Time -L—t'�A.M.--P.M. d/11-17- Address '2 Permit Owner Lot Builder The tollowing Building Code deficiencies are required to be corrected: t. Presented to 0 ["1 Approved A01'f/ Inspector Disapproved Date CALL POR REINSPECTION F-1 YES (J NO CITYOFTIGARD ® MASTER PERMIT ���� C-E':RMIT N. . . . . » . ; MST130 H1.1.G, COMMUNITY DEVELOPMENT DEPARTMENT oaFD 'RIM. PERMIT . : MS3T90 01.1f� 13125 SW Hall Blvd. P.O.Box 73997,Tklvd,Orpon 97 ( )83�4176 _ 1 i:)••1146 / I. DATE I ilalJE:D a 03/23/90 CI'T'E ADDRESS. . . : 1- 15tr'.r SW NORTH DAKOTA S'1 PARCEL: IS134CB -05100 SUBDI:VISION. . . . .. 0NTON PARK ZONING: R-7 BLOCK.. . . . . . . . . . a LO'T'. . . . . . . . . . .. . . ..13 PUll DING REISSUE: DWELLING UNITS-. 1 BASEMENT. . . . . . . . ..0 sf CLASS OF WORK. a NEW BE DRMS a 3 BATHS3:3 GARAGE.. . . . . . . » . . : 4(.-,2 ry f TYPE.: OF' USE:. . . aSF• FLOOR ARE::Aca._._......_ _.._....__..._.__ REQUIRE::D SL rBACKS... .....•....___.___...._.... TYPE: OF CONST. a5N 171RS*1 . . 1. . :9('7 s;f LEA-T. . .? ft RIG;-IT'. : 10 ft OCCUPANCY GR41. -.R::3 'SECOND. . . :E 8P) sf' FRONT. :20 ft REAR. . a 38 ft STORIES. . . . . » . :0 THIRD. . . . :0 ssf RE0 LJIRE:D••• HEIGH1'. . . . . . . . ..20 ft T0TAL.__.---__.... _ ; 1607 S SMOKE DETECTORS. cY FLOOR LOAD. . . . ..40 p<.sf VALUE. . ,. » . $: 842 1.0 PARKING SPACES. . a0 Rema•rFtss P L U M DIN G __...._.....__......__..__.- SINKS. . . » . . . . . . .. 1 FLOOR DRAINS. » . .. :0 BACKFLOW PREVNTRS. . :0 LAVATORIES. . . .. .. -3 WATER HLATERS>. . ,. ; :1001 TRAPS. . . . . . . . . . . . » . :0 TUB/SHOWERS. » . . r,2 LAUNDRY TRAYS. . . ;;I,) CATCH BASINS. . . . . . . ..0 WATER CLOSETS. . ;:t SE=WER L_INE:' (ft) . :N GREASE. TRAP'S. . . . . . . a0 DISHWASHERS. » .. . : I WATER LINE: (ft) . : 1.(a0 0 i'HER FIXTURES. . . . . 90 GARBAGE: DIS3P. . . : 1, RAIN DRAIN (ft) . :0 WASHING MACH. . . . I SF RAIN DRAINS— : 1 _._.__..___.._......._._._.-_._ 1%.(:HANICAL _.._._.--.__.._-_._.__..__.. _.__._..._...........___._.....-_. F"EES FUEL TYPES.--••-••-••-• - UNIT HTRS. . a0 type amount by date reept /GAS:/ / / VENTS . . . . . :0 PAYM $ 100. 00 ,TLH 03/20/90 J.07921 MAX INPUT a 0 BTU VENT FANS. . :4 BVIRT $ 388. 00 F'URN < 100K . . : 1 HOODS. . . . . . a1 BPLC $ 252. 20 F URN )~100K. — :0 WOODST OVE:S. go 85PC $ 19. 40 FLOOR FURN. . . . :0 CLO DRYERS. a 1 S'TDC $ 600. 00 BO I I_/CMP ( 311P-0 OTHER UN I T'S a 0 SSDC: 4, 250. 00 GAS OUTLE:TSi 1 PARK, $ 250. 00 Owrler a _._._.._.._........_................._._.....__.__....______.._._____._._..__..... ..._. MPR T' $ 3431. 00 TRIPLE L CONST. MPILC $ 9. 75 P. O. BOX 361. M5PC $ 1. 95 PP!RT $ 1,32. 50 BANKS OR 971.06 P5PC $ 7. :313 Phoiie b: 324•-•3051 PAYM $ J.8,Ji0. 18 ;JL.H 03/23/90 Corltracto•r a L.EROY LLL. INC". RT 1 BOX 316-2 BANKS OR 97106 FIhOrier N: b9332dI3@ J. ReqtF. . : 50084 _..__...._..__..____.__._._..._...__._._.._.___.._....._.._____.._.__..._.. __....... $ 1.950. 18 TO I'AL This permit 1s issued Subject to the regulations contained in the ----- -- REQUIRLD INSPECTIONS -- - Tigard Municipal Code, State of Ore. Specialty Codes and all other Foot/found Insp P J.i.1mb 'Trap Out applicable laws. All work will be done in accordance with approved 41tr VIroofinq B s m F-raminq Irlsp plans. This permit will expire if work is not started within 166 Post/Beam Insp Fireplace Irlsp days of issuance, or if work is suspended for more than 189 ays. Crawl Dr a i.ri Gas line Ins;p ti Pl.m/i.rndslab Irisp IIISLIl.ation 11-M13 Permittee Signature: PL..M/Unde-rf1.ncrr Gyp Board Insl:) Ftng Drain Bsm' t Rairl drain Insp 1 s;s u e d B y a -_..-_.._...._....._...-. _ _ _.___......_._. __._...._......_ M e e h a n i r..a l I n s r, W a t er L.i.rl e I rl ss p Call for inspection 639 4175_ MEN SEWER CONNL("T''[(*)N TYOFTIGARD 1-1 E R 111.1. ClTYOFTMRD F,E RM I'T Of. . . . . . . .. S W R9 0- 01 i?4✓ COMMUNITY DEVELOPMENT DEPARTMENT 13126 SW HWI Blvd. P.O.Box 23397,T4;aid,Or,Vw 97223(603)639-4175 V'R I'M. V'L•::R M1 T* L# 113 T 9 0-0 1. 16, nATF 5111 (IDDRESS. . SW NORTH I)()K0Tf) 13T' P A R C F-..L 1.S)13 4 C'D 0 5 1,0 G UFID i V I S I ON. . . . ON1 ON r:10RK ZONING: R BLOCK. . . . . . . . . . . LOT'. . . . . . . . . . . . . . 13 I'F::NoN*T* NAME. . . . . : (.JS() NO. . . . . . . . . . :40624 F I X'T'U R E U N Yr s,. . . - C.I ()GS OF WORK. . . :NEW DWELLING L T'YF:IE OF* USE. . . . . ..SF NO., OF" 13U1LI)1N(35.- 1. TNGTALL TYPE. . . . .FJLJSWR I M P E R V !3 U R F'A C 1---.. . Rpnia-rk%i ..................... ........... FF:ES T'R T r-1 I V L CONST. type iA M(:)(.t 1-1 t lay date -r ee 1)t P('.)X 361 FIRM'T $ 1-250. 00 111 S 11 $ 35. 00 DONKS OR 971.0(:, I-IAYM $ 1285. 00 JLIA 03/i.?3/90 VIlic)rie #-. 324-13051 C(:)ri t Y,a c t(:)-r. ....... ..................... CON'TRACT'OR N01* ON FILE ................ ........... $ 1.085. 00 T'01'OL- ....................... REQUIRED INSPECTION,1:3 This Applicant agrees to comply with all the rules and regulations Sewe-f- lrispertic)r) of the Unified Sewage Agency. The permit expires 128 da'Ys from the date issued. The total amount paid will he forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sever laterals. If the sever is not located at the measurement given, 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 Sever" Permit and the Agency xyill in 11 teral. V,e-r ni i t t e e S i g ri a t t t (7:1 ............................. I i:;i;t.t e(i P y .......... ....... .............. ........... ............................................ C,1 11 fa-r :Lrispeetic)ri 6:39 -41'75 ff I ci*rY' OF TIGARD RECEIPT OF PAYMENT REC. NO: 001.07996 CHECK AMOUNT 3115. 18 NAME: TRIPLE L CONSTRUCTION CASH AMOUNT t .00 ADDRESSt P0 BOX 361 PAYMENT DATE t 0,3­211-90 BANKS, OR q7106 BLOCK NO/ADDR: TICAPD, OR 97 ;*:3 1.2565 SW NORTH DAKOTA PURP03F OF PAYMENT AMOUNT PA 1:G PURPOSE OF PAYMENT AMOUNT PAID BUILDING PERMIT (90-0116) "88.00 PLUMBING PERMIT 133.50 flECHANICAL PERMIT 39.00 STATE BUILD PERMIT TAX. 15%) 28.73 !-'LAN CHECk FEE 161.915 SEWER USA 190-01241 1,250.00 SEWER INSPECION 15.00 STREET SOC 600.00 PARVS SYSTEM DEVELOPMENT CH 230.00 STORM DRAIN SDC 2,50.00 TOTAL AMOUNT PAID C ONOF TIFARD 41, utroft e► APPLICATION � PLAN CHECK COMMUNITY DEVELOPMENT DEPARTMENT / Y; PLAN CHECK N 11125 S.W.Hal Bbd-P.O.Bon 23.397.T19+n4 oega+SrM.(SM)$744175 ` PERMIT N '• L' -- 'q U DATE ISSUED I� t JOB ADDRESS: lY✓r' JVJ ter}� .y� ' TAX MAP/LOT /S I 34 C G - SUB: LOT: / _?, LAND USE: _..[�l�f'�''h.� d��-i-/C - - ---- VALUATION: _- OWNER I I I SPECIAL NOTES NAME: _ / 1,7 e—� re;r� — REISSUE. OF: r ADDRESS: r LAST REISSUE: 7, FLOOD PLAIN/ SENSITIVE LAND: CONTRACTOR APPROVALS REQUIRED _— PLANNING: NAME: ^��Z t' ENGINEERING: ADDRESS: _ FIRE DEPT OTHER: PHONE: _ ITEMS REQUIRED BUILDERS BOARD N: EXP GATE: z- _ y'/ LIST/SUBCONTRACTORS: BUS TAX: ARCH/ENGINEER / CALCULATIONS: NAME: TRUSS DETAILS: ADDRESS: OTHER: _ PHONE: — -- COMMENIS: SUBCONTRACTORS: PLUMB: //a �S �n _/.;' MECN: >_>Sh5 � /PERMIT N ACCT b DESCRIPTION Gi� AMOUNT AMOUNT PD. BAL. DUE 10--432 00 Building Permit Fees /6 = 3 � _ 10-431 00 Plumbing Permit Fees ✓ 3�,Sv -� Y• -Z 10-431 01 Mechanical Permit Fees 10-230 01 State Building Tax (5%) _ Building _/y �!�+ v' F. 7'S Plumbing Mech _ _Z 10-433 00 Plans Check Fee Building Plumbing / Mech 'R U UlZ y 30-202 00 Sewer Connection /� �C' _ _ 11 S� 30-444 00 Sewer Inspection 51-448 00 Street System Dev Charge (SDC) lv C C' C' 52-449 00 Parks System Dev Charge (PDC) CI _ 31-450 00 Storm Drainage Syst Dev Chrg (SSDC) 10-230 OG Fire TOTAL RFC N APPLICANT iJGNATURF Received By: L Date Received: �.�_ >/ _ --�)-L)— cn/3587P/18P 7f�� ClTv OF TIGARD RECEIPT OF PAYMENT RFC NO: 00107721 CHECK AMOUNT 100.00 LLL, INE, CASH AMOUNT on ADDRESS- PO BOX 361 ;:'AYMFNr DATE 0.:1-- 0-q0 BANKS, OR 9-7106 BLOCK NO/ADDRs LOT I-,', ANTnN PAW PURPOSE Oir PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID PLAN CHECk FEE i3-60R) I Orl.CIO II TOTAL AMOUNT FAf[) w w w w w w GRADIN(=/,R SI )N CONTROL INF )RMALON GENERAL CONTRACTOR NAME&ADDRESS: CASEFILE NO.:— PERMIT O._PERMIT NO.: 1 <1 .A--� C7r s lie _ APPLICANT NtME AND ADDRESS: EXCAVATION CONTRACTOR NAME& ADDRESS: �'-z: -- l�rl i✓I�-,S �r OWNER NAME AND ADDRESS: TELEPHONE NUMBERS: APPLICANTi �� ti �' ' � _ PROPER'T'Y DESCRIPTION: OWNER a �/ 31'- STREET ADDRESS AND CROSS STREETA OCATED GENERAL CONTRACTOR: — EXCAVATION CONTRACTOR: 31 Y SITE/JOB: —- LEGAL.DESCRIPTION: 24 HR/AFTER HOURS EMERGENCY TAX LOT NO.: C NTACT PERSON,TITLE TELEPHONE: 1/4 SECTION: _ I 1'v rs 31Y 3C l SITE SIZE,ACRES: DISTURBED/WORK AREA,ACRES_ LOCATION&ADDRESS WHERE SPOILS LEAVING SITE WILL BE TAKFN �RUNOFEDRAINS TO:(CIRCLE ONE) (Nont:PERMTS MAY BE REQUIRED) CATCH-BAS DITCH PIPE CREEK — -� (CIRCLE ONE) PRIVATE PROPERTY -- —' PUBLIC RIGHT O�~ EROSION/SEDIMENTATI N CONTROL (L SC) MEASURES MINIMUM ESC REQUIREMENTS MINIMUM ESC REQUIREMENTS DUPING CONSTRUCTION: FOLLOWING CONSTRUCTION: SEDIMENTATION FACILITIES STABILIZE EXPOSED SURFACE STABILIZED CONSTRUCTION ENTRANCF. REMOVE AND RESTORE TEMPORARY ESC PERIMETER RUNOFF CONTROL. FACILITIES CLEARING AND GRADING RESTRICTIONS CLEAN AND REMOVE ALL,SILT AND DEBRIS COVER PRACTICES ENSURE OPERATION OF PERMANT FACILITIES CONSTRUCTION SEQUENCE OTHER OTHER PLAN FOR EROSION CONTROL PREPARED AND SUBMITTED IN ACCORDANCE WITH"TECHNICAL GUIDANCE HANDBOOK". EROSION CONTROL.PLAN DRAWING,AS REQUIRED,HAS PLAN CONSTRUCTION NOTES COMPLETE,INCLUDING EMERGENCY PHONE NUMBER, SCHEDULE/STAGING FOR INSTALLATION AND REMOVAL,OF EROSION CONTROL MEASURES,AND APPLICABLE.STANDARD NOTES. 1 HAVE READ AND WILL COMPLY WITH THE ABOVE AND WILL CONSTRUCT AND MAINTAIN ESC MEASURES AS NECESSARY TO CONTAIN SEDIMENTON THE CONSTRUCTION SITE. OWNER SIGNATURE APPLICA SIGNATURE • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • OFFICIAL USE ONLY, RECEIPT DATE ACC[;F TI.1) F::1 NUMBER RECEIVED --- BY ms w w w +w w �I wt 1 ' TRIPLE L. CONSTRUCTION ROUT[ 1, •OX 316.2 •ANKS, OREGON 97106 �- + - - - - - it L I � moi. / � -.- - •- �0� � _—_ � ��J_.��-��_ I -r.. _ _. __.. _.._. /7 t '► w