13163 SW TAMERA LANE-1 13163 SW Tamera Lane --
ClTY0FTlFAP,0 CEROCCUPANCYOF
COMMUNFTY DEVELOPMENT CEP"T&WXT (CrTYC 7WARD r t_RMI T
13125Sw►mliBivc4 Pu.F3ox23397,Ti d,a ormhoN FRIM. vE:RNIT' 0. a 89166L'
as epos 97223�6o3►s3u4175 D•4TE I,SUED o
SITE ADDRESS. . . 13163 SW TAMERA LN
SUBDIVISION. . . . VILLAGE AT SUMMER LAKE PARK PARCEL: 1i3133DC 15000
BLOCK. . . . . . . . . ZONINGS n-12
[:I.AiS OF WORK.. iNEIJ.�__... __.__...._._.___._..__..__.__._..._._.._.. .. .... __.___...._...__.___.__.....__....__...__._..___.._.._.___
TYPE OF USE. . . I SF
OCCUPANCY ORP. vR-
C!'XUPANCY LOADS
FFNAN' ;;AME. . . a
Ftr,marl�.�x r RE--10SUE OF 881728 $39 fOt` 2 reed 1 ?ne Copies I
DON MOHlb,=,ETTE
PO PDX 19!e4
PORTLAND OR 00000 -0000
Phone Hg QP0- Hu34?f `�00k1
Contractors _..___.._. ___...__....._...
DON MORISSETTE DLDERS, IWC. _....... "" __..._. _
P O Box .1952 ►
PORT LAND OR 9,721.9
Phone Me 503 -244-9314
Reg #. . 1 3, 533
( CCUPancy of the above refvrenr..ed building is hereby given, ar►d r.:prtifis!s
the COMPliance with the State Of Oy,pgr3rt SPE»ci.alty t.c3de� for tl�e grn,�p,
o':c�rP+�ncy, pend "Se r.rndp•r which than referenced pw.rmit was isfat(pd.
F"IRC DEPARTMENT��
vulLD
HUILDi4 OFFIC AL —�
POST IN CONSPICUOUS PLACE
I
i
I
w�
1
INSPECTION NOTICE
City of Tigard Building Department 7—
P.O. Box 23397
Tigard, Oregon 97223 O
Phone639-4175
1 ,'5
Type of Inspection
Date Requested. f / — 74 Time _ A.M. P.M.
AWIress �� �� —=4 L''�—s' —_ Permit #
Owner /� Lot # _
Builder /i- �'. 4eZLsyJ Z- W�
The following Building Code deficiencies are required to be corrected:
-
C- --
J
��--�-L -
Presented to _ Approved
Inspector
Disapproved
Date _ �i `
CALL, FOR REINSPECTION
C l YES ❑ NO
INSPECTION i`i.',)TICE
City of Tigard Buildinf; partment
P.O. Box 233..,' i
Tigard, Oregon 97223 !!
Phone: 639-4175 1
Type of Inspection
Date Requested Tim _ .M. P.M�.�
Address _�LT`� = � Permit �rC '1
Owner __ _ — Lot
Builder _ t1 Z,cam , Ltc_- --- t
The following Building Code deficiencies are i,.,luired to br corrected:
tC 1 --
. 1�tac:�p�t --
,., tic421 pro .l'1S�)C_712 --
Presented to �—T–.—_— � Approved
Insuector �p W. _1 Disapproved
Date _����^ `� -
CALL FOR REINSPECTION
❑ YES ❑ NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon .!7223
Phone: 639-4175
Type of Inspection J►L"�- � '== -----_
Date Requested Time_--- _ A.M._ � P.M.
Addres.. _ _ 1_..__ �w �J Permit
Owner Lot
-7 r
BuilderThe following Building Code deficiencies are required to he L_,rre^ted:
_-. ..
-s.
Presented to _. — -Approved
Inspector - - FJ Disapproved
Date -
CALL FOR REINSPECTION
❑ YES ❑ Nr'
w
INSPEG "ION NOTICE
City of Tigard Building Department
I P.O. Box 23397
/
Tigard, Oregon 97223
Phone- 639-4175
I
Type of Inspection C0_-C_41` '� t(E��✓��—�C_/t__.
Date uetted
Re4 ',�
`�. June�A.M. � P.M.
Address ���/ !� <�-� Permit *_97
7
Owner �— , -- —
_ --
t;milder
The 'olloWins-Be o e deficionei(is are required to be corrected:
17
--- .,5'� -- -- - - -- -
LIP ccJVL
PO C:4 yn
_ <<
Presented to _ I Approved
Inspector K Disapproved
Kato :_4—1c)
CALL FOR REINSPECTION
CK YES ❑ NO
INSPECTION NOTICL
City of Tigard Building Department
P.O. Box 73397
Tigard, Oregon 97223
Phone: 639.4175 .
I �
Type of Inspection
Date Requested __ �___ Time A.M. P.M.
Address 1� _ �J �-! �_ Permit fe7.L�
OwnarLot
I )/ ► #
Builder ----------- - -- �_.------ --_
ThP following Building Code deficiencies are required to be corrected:
Presented to -_.--____--— --_- -_-_—_—_._ Approved
Inspector ❑ Disapproved
Date ------------_ _
CALL FOR REINVECTION
❑ YES U NO
a.
It i s�
INSPECTION NOTICE
City of Tigard Building Department
P.U. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Data Requestao Time A.M. ___ P.M.
Addr s z
fAl Permit
Owner �� L(�Z�Q(_ _ Let # _
Builder ` -_2�ti✓ Y '2 t� �_
The following Biliding Code deficiencies are require to e corrected:
Presented to
Inspector - - ❑ Disapproved
Date -
CALL+ FOR REINSPECTION
❑ YES ONO
�w
IN.3PECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection _� — -- —
D,te Requested d Time __ A.M._ P.M.
Address _ .� Permit #
Owner_
. ,L Lot # 4L-
Builder
The following Buildit7 Code deficiencies are required to be corrected:
C%
WA
Presented to _- _ - -_ ❑ Approved
Inspector _ - V1 Disapproved
Date •� - /—tYr -
CALL .F'OR REINSPECTION
O YEs CJ NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection --ice ' 42 --
Date Requested Time_-�___ A.M. y P.M.
Fermlt
Address --
# Q_
O% nor Lot #
Builder -.-----
The following Buildinq Code deficiencies are required to be corrected:
I
57:
W,�—
Presented
to _ — ; Approved
Inspector ��- �••,,. _
__` Disapproved
Date 1 �• [� / _ ---
CALL FOR REINSPECTION
0 YES 0 )
wW w w w Ww
INSPECTION NOTICE
City of Tigard Building Department
I
P.O. Box 23397
f
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection —
i
Date Requested 0/j F Time ._ A.M.---P.M.
Address 43j �_gg — Permit #
Owner.-- Lot
Builder i��� —` � - --------
The following Building Code deficiencies are required :o be corrected:
— -- — �0,
de
I
Presented to [�'4proved
Inspector _ J� --_�_ Disapproved
Date
CALL FOR REINSPECT,ON
[] YES 0 NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Q Phone: 639-4175
'Type of Inspection �S7
Date Requested — Time A. '.nl -i=^ p-
? Permit 4'_ l Lx�--
Address
Owner _...—
Lot —
Builder
The follov `ng Building Code deficiencies are required to be corrected:
Presented to _�-"" � +—_--- -- — I, Pro%dd
Inspector � .-- _ �.� Disapproved
Date
CALL FO RFIN5PF.CTION
❑ YES C_? NO
/ INSPECTION NOTICE
'•vv ��r��� City of Tigard Building Deparhnent
/ P O Box 23397
Tigard, Oregon 97223
Phone 639-4175
Type of Inspection _�j P.M.
Date Requested--L— C
Permit #
Address
Lot #
Owner
Builder ,
The following Building Code deficiencies ere required to be corrected:
Approved
Presented to _
Inspector --------- —_
Dis,pproved
Date CALL FOR REINSPECTION
DYES ONO
WWI=
INSPECTION NOTICE
G✓" City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection —'" fL/(
� ._ ✓--
Date Requested Time P.M.
!�
Address . _ .�/e ». ;�z-� _ Permit # G^ �-
Owner_ Lot #
Builder _ 3 /
The following Building Cede deficiencies are required to be corrected:
Presented to Approved
Inspector 7 ❑ Diapproved
Date S S
CALL FOR REINSPECTION
0 YEs Cl NO
HU I,I DTNG mi;�nmrr
TY OF TIOA RD I t I PF,.WM1*T NO. : Bl'J'891662
trRoCIFTY OF TIMM ✓
COMMUNITY DEVELOPMENT DEPARTMENT MOON [)AIE T'SSUED: B/ 7/89
13125 S.W.Hall Blvd..P.O Box 23397.Tigard.Oregon 97223.(503)6394175 (C
Pn'l:m . rm,r.NO . (391660
JOD Al.)UPI;:'SI;; : 1,53-63 SW T()Ml:PA L.N
I'-'-)X MAP/L.01' 1.51 33AD 15000
I AND USE:: 174,11:)D Sl-)": "Ll-AG1. Al 511-IMMEEPI AKE PAPK 5 DK :
VAIAJAJTDN : 111, 11.'7 ,;'1;.30 SKTDACK!:1
F-"PON 1 20 PF--AP : 1.0
WORK ItLASS . NEW DWE I.J.. . UN 3: T'S LEF 1 1.0 PlIGHT : 35
USE TYPE : STN'tA.1- I- oM1.I..Y NO . 0F.-A)ROOMS : 'el EXT.WAI-L (:'ONS*T* :
cmNs'r. TYPE: VN NO l:?A'THG : 3 N: G : E : W
0C.CUP . 13PI'). 1:4:3 PP(TT -OPENINGS .
OCCLA:'.LOAD N S : E, W
'TOTAI... AREA: P6159
NO . STOP11ES : a IS T ; 1269 ROOF:' GONS*r: c, Friw r4i---r-?
20 2ND: 3.390 APF:'A SEPAR'? AA*T'F-*,:D:
BAGE-MEN'T"? 3PD: OC CUP- SENDAP71 PA*ru):
MEZZAN.1NE"? BASLM' T
1:711-0011 1 OAD : AO GAPAGPK : !*.)60 F: TRE: !ii PPKI r:i'? ALARM?
FLOW((.;V)M) , yF:-.S
L
IIE-Ar 1'YPK: G65 A(:',0EGS7 (:-(, -1'?
V-LAN GHEGK 1:)Y :
PF-MARKS .
OF 881.7213 REISSUE OF NO. 8817VU
$30 ft)r r2 red li.ne Lnnpj.r.�q; L»AST' PEISSUE;'. sel,933
E E S
0 MOR J:5 5 1-.T*T 1L.- DON PIE PMX T
W 11147 R . 0 0
N pu HIOX 191111IRX4 P1 AN PEV:r.F--'.W *10 . 00
FIPIT DE.P1,
SI'A'11-': TAX 11111215 . 90
cjin-w:rT 11111*30 . 00
C OV'VELOPMEN'T C,H A P S
0 MOR1.9SE T FE DON C W
N UON MOPISSii.1-TE .3 11STORM) *2bo . 00
T SK)CO-sl WE'E'll $600 . 00
n p $250 . 00
A
C vr < $40 . a0>
T PF-IONtK (503) 214 9314
NO . 35,0$33
R I J 'TUTAI $1 631 vo
This permit 19 Issued subject to the regulations contained in Title 14 RE(XI.P'r NO
of the TMC, State of Oregon Specialty Codes.zoning regulations PEQUIPED XNSPE( -1-:f0N5
and all other applicable codes and ordinances, and It is hereby
agreed that the work will be done In accordance with the plans and FOITTJ NO S E WE R
specifications and in compliance with all applicable codes and FOUNDA'1*10N WAI L RAIN DRAINS,
ordinances. The issuance of this permit does not waive restrictive POST A REAM Wf)'YE'P I-INE
covenants Contractor and subcontractors shall have current city PL U . UNDEVO-A-AH (.,I VY APPP('.1H/SW
business tax permits This permit will expire and become null and
volt,if work is not started within 180 days.or if work;ssuspended or L A Ei
F T.NAI..
I
abandoned for a period of 180 (lays any time after work has 1:11-191 . 1,0POUT
commenced !t shaLbe the responsibility oft)JI"'Ninittee to assure FRAM I N(.v
all required !nape ti(;F are requested and prov d
(.;AS L'I NE
1:N ri UL.A T I ON
GYP 1-10AND
Permittee Sign4kq"
,qsued BY: �Ae— l("'M I VOW IN611J64-4-11.1i'llhil
SEPARATE PERMITS REQUIRED FOR W09K OTHER THAN DESCRIBED ABOVE
WNW W W W W1 W-11111KAW
CI7Y OF T'6A RD P1 UMBING PERMIT
CITYOFTWARD PF1:*,'M1 T' NO. ; PLI13916-10
Ty
ORIG
COMMUNITY DEVELOPMENT DEPARTMENT ON
13125 S.W.Hall Blvd..P.O.Box 23397,rigard.Oregon 97223.(503)639-0 175 04) (L'. ISSUED: a/ 7/09
FlITTT—PIN'll I
11.31.63 SW TAML.1-1A I N
(()X M111P/l (')1* 1.53. 33AD 1.5000 !;iLJl:) : VIA.A.-AL'A.. AI 'A.IMMAILAII(L. DANK LT 5 UK :
LAND WGE . P MID
L(TI 51Z E. :
ITEM : NO : NO .
WOWK CLASS : NEW WA FER CL.OSV-.:T 3 TPAP
tPil:i: *T*YPl'--*' : 51NG1.+-- FAMT.I Y U114'I'NAI LO
DKIFW PRVN1*I:','
GONST . TYPE; VN I AVORATOPY 15 TPAP 11:14JIMLP
OCCUP.GAP . : P3 1110 51-10WIH.44 (l:*-:A�iE T'PAI:)':)
1:)151-11WA51••IF-3:4 1.
GAWBAUE'. 0:0il;:'C)GA1 1.
NO- STORIES : 2 WASHINt.', MACHINFE 1.
DWEI.J... .UNI.T!*5 : I I TWAY AUNDRY RILDG. DPAIN (DIA
FLOUP DPAIN
!:il N K .1 s-:wi,.- F"r
WA*1'1:::r4 HEA*TEA 1. SIOAM/PA'I'N (FT I.
OTHEP
NES MAI'aKw
W
N M(:)AJ:!;5ET*T'r--: DON PFJIMIT $140 . 00
E lap ROX 3.95211
R F)u r*Vl.a n d C)11', FIXTUREsi
S'T*A*T*F.-'.* TAX $7 00
C
0
N HARLA-D
T
R 5H(*-"MA0:'1:41S PLUMBING
A r)1l BOX 2-50
C
T Offitffl-CAICIM t:)r, 9*70P3
0 F-IHONE (503) 6.30 1 T20
R
t I hill-I 3cipp 1131 AL $3.4'7 . 00
This permit 19 issued subject to the regulations contained in Title 14 NECCKIPT NO.
of the TMC. State of Oregon Specialty Codes,zoning regulations ................ .........
and all other applicable codes and ordinances. and it is hereby PEQUIRED INSPECTIONS
agreed that the work will be done in accordance with the ptins and
specifications and in compliance with all applicable codes and P11-8 .UNDEPlil AR
ordinances The issuance of this permit does not waive restrictive 11-1011T & 011n:Am
covenants Contractor and subcontractors shall have current city WATEP LINE
business tax permits This permit will expire and become null and 11'.'11-113 • TOPOL)T*
void if work is not started within 180 days,or If work is susperlded or RAIN 014AINS
abandoned for a period of 180 days any time after work has
commenced 11 shall be the responsibilit f the permittee to assure 1-1 NAI
all required i ctlons are requested n pproved.
Permittee ure
Issued By-
CAL I 1:4.11r) 'r.Nl;pr..:(:.,, inN
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
P1.4::-M PMT*.N0 091662
MF-."f.',HAN:L CAL PERMIT
CITYOFT19ARD A-1.09\ Pl::'I:,M:1'1' NO . M1*::-*JJ9J6,11.
Clrf OF TWARD
COMMUNITY DEVELOPMENT DEPAI-.'TMENT 0*100" DAI 1::: ViiPSUFf
13125 S.W.11a11 Blvd..P.0.Box 23397,Tigard,Oregon 97223,(503)6394175
JOB ADUNF 13:1-6 !:)W 1AMCK8A LN
VAX MAG-I/LOT I'S11 135AD l !)000 SUE VILL-AGE" Al' SL1MMI-.*1:4L(-)KE Pewl< L'T : 5 Bl<
I ANL) USE:: A r1`0
1. 01 15IZE:
ITEM N() N(:)
WOPK CLASS: NEW FURNACE <100K :1. ATP HANDI 14 <J.0
USE TYPE : FAMIL.Y F-UPINACE 10OK-11- :1. AIN HANI)i 1:4 10K
CONST . TYPki. : VN FLOOP FUPNACF.-*.'.
()MUP. GPI.-J. . 83 HEATEP Vl'-"Nl' FAN
VE N'T V N 1' . 5 Y S*r F:M
1311...8/COMP <31.4p
NO. STOAT.E's F31 P/GOMP ;3-1.151.4P INC I NEPA TOP(DOM
DWELL . UNITS : 1. BI-1:4/COM I--' 15 301.41, TNCI 1'.NF:'PA,rc1li:;l(cc)m
1-1.)F-'.:L 'TYPE: D,I n/COMP 30-501-11:1 1:11UPO"J4 LINT IS
MAX . INPU I* /COMP 50-H-4P (J1"HEP
FJPE DMPRS7 (3AS P.H..':I:NG
HIGH PRESS'?
I OW 1:44ESS.7
l4k:-MAA1<S :
wo MO P V-1 S E DOI,) PFAIMIT 11111.U . 00
N ))U 1:X.1X P1 AN RIEVTE W
E $9 . 75
R p ci r t:1.m.ri(I C)1 $29 00
TAX $1 .
01'HE.14
C
0
N
T BEA.-1HIE'ATING INC .
R 1.405;505E: PIAZZA AVE:
A C,I.-AKAMAS
C UOn 7
�� 0:11.5
T 1.13{I
0
PEGUYTRATION NJ . -017 'TUTAI $10 . 70
This permit is issued subject to the regulations contained In Title 14 PEC E.APT NO.
of the TIVIC, State of Oregon Specialty Codes,zoning regulations
and all other applicable codes and ordinances, and It is hereby PEWILUPED INSPECTIONS
agreed that the work will be done In accordance with the plans and 1.NF:
specifications and In compliance with all applicable codes and 1:101i7* a HEAM
ordinances. The issuance of this permit does not waive restrictive POUGH 7:N
covenants. Contractor and subcontractors shall have current city I NAI
business tax permits This permit will expire and become null and
voirl if work is not started within 180 days,orifwork issuspended or
abandonbd fr,.- a period of 180 days any time after work has
commenced. N shall be the responsibility of the permittee to assure
all required i actions are requested and approved
ure
rT4
"ttee u
Per jne"'
Issued By t-7� -
SEPARATE PERMITS REQIIIRED FOR WORK OTHER THAN DESCRIBED ABOVE
1)Al L-*- I!:i! t-I P.:D : a/ �1/09
CITY OF TI67A RD cff�Lw .SEWER PERMIT ✓
COMMUNITY DEVELOPMENT DEPARTMENT 0110MON PEAMT*y NO . : SE(39167P
Imm S.W.HA MIND.Box 23397.Tigard Oreyon 97223.(503)6394175
PRI M . LMT .NO . 1391662
JOB ADDRESS : 13163 SW TAMIL PA LN I.P�sA NUMWA:I : 39013
TAX MAPILOT 1.51. 33AO 15000 508 WILLAWE Af WIMMEALAKE PAPK I-T . 5 BK :
I AND USE : P7PD
LOT SIZE:
!iECTION: 33 T,wl, : :1.5; RNG : 1w
WORK CLASS : Nli::W
USE TYPE : SINGi FAM11. Y
The applicant agrees to Comply With all rider and rOqUIMIA.01111 Of the
Sewerage Agency . The permit expires IRO days from the date issued , The total.
amount paid will be forfeitad if the permit expires . lhe Agency does not cIuar-
antes the accuracy of the lonatiun of the mi ds mawe.-i- lattersiklii; - If 0-le, 1:iewer Vi
not located at the meam"rement give" , the installer mhu3l prospect 3 feet in
all directions from the distance given If not Mo thow iniacallar shall
purchase a "Tap and Side Sewer" Permit and the Agency wi.1.11. inititakil a
INSTALL . TYPE : BUILDING SEW1!-.n IMPI:NW1113tis APEA:
FIXTUrOK UNITS: TENANT IMPROVEMENT :
DWIF-3 LING UNI:T'S : I
0 FEES :
W
N 1`10PISSET-TE DON PEWMIT 111135 . 00
R
E p c) r-iOX 1.19 2.44 CONNECTION CHAP(*.,E St ,250 . 00
Portland m r I INE TAP INSTALL.. .
C CITHE 1:4
0
N
T MOPISSETTE DUN
I'l DUN MORISSETTE BUILDEPS INC,
A
C p 0 Bt:)X jj.q.�Lazl
T partland or 97219
0
R PHONE (�)03) P.4141-93141
14MSM Tu'rAL: $I ,E!85.00
This permit is issued subject to the regulations contained in Title 14 R1--:C',ET.PT NO .
of the TMC. State of Oregon Specialty Codes,zoning regulations --------
and all other applicable codes and ordinances. and N Is hereby REQUInED INSPECTIONS
agreed that the work will be done in accordance with the plans and
specifications and in compliance with all applicable codes and POUGH---I N
ordinances The issuance of this permit does not waive restrictive
covenants Contractor and subcontractors shRII have current city
business tax permits This permit will expire and become null and
void It work Is not started within ISO 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 Jredpect ions are requested and approved
itt afore Parmitt, aWre
issued By -1,IA-
al I.. V 014 INS I-II I ION e.,39 z4.[7:)
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
1. r
U.•� � ��� `1.
7L o1) CcV1 V1 V7 V7lt.N ;�.
loll
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hG160 6861 '10'80 31135514OW N04 WOaj
ICITY O TWA' RD �� PLAN CECAPPLICATION
�"1pD PLAN C{ECK N -
C(-)MMk-41TV DEVELOPMENT DEPARTMENT PERMIT 6 -
�i�nsw-�c«oae.P-o_tseRu�ar,T�..no.� .sra�.iswlwv-��rs DATE ISSUED
JOB ADORI_SS: 'S(w S I Y�1� � ►✓1 L N -i AX MAP/L..OT /5�' S 3 4
:SUB: V llLvlLA-L, (1 C l yiwer Q LOT: IS;- LAND USE: _VALUATION: t '"` y' moi, //7 53 0
OWNER - r ' SPECIAL NATES
NAME: r.� 'yl4l• /S 6, i c til , _ _ REISSUE OF:
ADORCSS: r"A LAST REISSUE: -
( t �'Z ( FL000 PLAIN/
SCNSITIVE L.ANO:
PHONE: ` `'�� 3 LL
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APPROVALS gE2!IIRCO
CONTRACTORPLANNING:
NAME: _ - !L ENGINEERING:
AOORESS: FIRE DEPT
OTHER:
PRONE: ITF11S REQUIRED
— LIST/SUBCONTRACTORS: _
ARCH/LNGWEEP / n BUS TAX: _
NAME: - tr' 1 C f TZ') �` r CALCULATIONS: -_
ADDRESS:
TRUSS DETAILS:__
� —
_ _ PARKING PLAN:
LANOSCAPE PLAN _
PI{ON : J 0WER:
COM LNTS:
PERMIT N ACCT y DESCRIPTION AMOUNT AMOUNT P0. BAL. DUE
' L L 10-43' 00 Building Permit Fees
1('-43 ('7 Plumbing Permit Fees /
1Q A3 01 Mechanical Permit Fees ��f -
10.-?30 01 State Building Tax (57.) —3ZV
Building — . r o _
Plumbing
Mech
10-433 00 Plans Check Fee ♦rte / U
Building
Plumbing
Mech
30-7.07 00 Sewer Connection -
30-444 00 ;ewer Inspection .$ 35_-
51--448 00 Street System h(zv Charge (S0C) —�- GCI
52-449 00 Parks System Oev Change (P0C) ,rZ 0 ASO
31--450 00 Storm Drainage Syst Oev Chry (SSUC) ,AS O SS U
10-730 09 1 RI-0
10-730 06 Washington County lire #1 (957) -
LO-720 00 A _rL/Wedgewood
101"AL - UREC It
T
AI�PI.-ICANT IGNnTURE
Received By: _ _ -_ — UaLe Received:
cn/3587P/18P