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15800 UPPER BOONES FERRY ROAD-1 i • Sto t►�n+1 l X11..I:" � �'�' f 3'r�' �.. �"•�" 1QD QUMirT IPS 6 ttw.IEI. . 17 1 ► OAT_ .1---�..�.,� ..r._ .�..Y•....._... b.w..,...�...._ ...,..,.,. .... ..n............ ..,.�_� w Y..➢t�u i tom._._....... ._._..._. ............•.. ..�......r '; �' low- • r I ro-M ----_L) (7 ' 6' P R I NIT fE D Cop r�MW.�M..'.AN'M.MM•�.r+.•,.Fx.wsM./...h+..r..•,►,.._.�wr•.,�•wYwr.r.Mw�a . � +r,...�y,.'"n/r"" ,,..r.,. .•..w.ti".+w..Y.,•.w. +, .s.•.�,,..,� , "-"w'•+••+.xy .. .,. ...x... �. � APR 8 1Q80 � �r r PRELIMINARY 10, 3• CPN . PERMIT Nr, . ? 8--80 1 i� ' Q. 'M� s i• -* - *�` ••� w r wom Ap­ VnW - .. $01110. . � V' � _ "+. _. �, '-r. ,� __...!7r• .r,-'.-.... _ ___+�r . .--+.... --`�-_w'-•- v: a..a:.=''' -�M;1-` .- ....,,, --*►..._ ._•'�-_." 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UPPER BOONES FERRY RD.- 15800 f , CITY OF TIGARD--12420 S.W.MAIN--TIGARD,OREGON 97223 ,� RECEIPT DATE. �"7/ J _—_AMOUNT: S v LLARS NAME: 0.t �''�^O�� CASH: ; , ItC r' ADDRESS: c3�.S S ki ' �DCI. ~�y f _ ZZZ M.O.: • OF FOR: ACCT. 0 PERMITS SURCHARGE AMOUNT Sr_'W"R oiLLINGS 40-364 BUSINESS LICENSE 05-331 PLUMBING PERMIT 05-332 MECHANICAL PERMIT 05-3:32 BUILDING PERMIT 05-333 SEWER CONNECTION 40-363 SEWER INSPECTION 40.365 SYSTEM DFV CHARGE 25-366 PARK DEV. CHARGE #1 30-367 PARK DEV. CHARGE *2 30-366 ZONING ADJUSTMENTS 05-362 C - l� L y0J _ ---- --- — - -- -- _— —.—� TOTALS- ---- S ------S20- "- 46 PRRECEIVED BY. PERMIT NUMBERS ASSIGNED: A Number Amount Number Amount Number Amount -RECEIPT M 5609 , �e APPLICATION - STREET IMPR :MENT/EXCAVATION COPY TO: ( ; (WHITE.) - FILE ORDINANCE NO. 74-14 ❑ (BLUE)-INSP. �I (YELLOW) .OTHER AGENCY (INSTRUCTIONS ON SEPARATE SHEET) n (PINK) APPLICANT APPROVED APPLICArION NO.: NOT APPROVED JJJ❑��� CI Y OF TIGARD, OREGON FEE AMT.: S Re, �r� PENDING FEE, PMT. ❑ CITY HALL. RECEIPT NO.: '54'Ly 9 PENDING SECURITY ❑ PUBL IC WORKS DEPA R TMEN T BY�,� DATE— 41 PENDING AGENCY "OK" ❑ Application and Progress Record MAINTENANCE BOND PENDING INFORMATION INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED ❑ ANNUAL U PENDING VARIANCE EXPIRATION DATE: PERMIT NO.: DATE ISSUED: BY: 1� �'� "'�`' (1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL — AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS. APPLICANT __ Ken Hood 1-6740 S.E. vineyard Ave. MilwAukie 654-8584 A - ADDREO CITY HP ONI- CONTR.ACTOR Ken Hood 4onstruction 16740 sF. VinevArd Ave, Mi1waukie Ori _ 654-8584 ADDR Sti ITV -��10 IE- PLANS BY ---- -- NAME - ADORE S CITY ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S 1.020.00 DOL%Ars FOR OFFICE USE -_- d 4 MIN. (2) EXCAVATION DATA: o.oz x s�.--_-- =i STREET DESCRIPTION PROGRESS & INSPECTION STATUS— NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE @Y lJpp TYPE LENGTH INIDTII DEPTH ITEM & QUANTITY Booneq Ferry STgREEU — _ = TION Q ---_ _ u ESTIMATED STREET OPENING DATE:_ I' 1Q Z 3 S T -- ESTIMATED STREET CLOSING DATE: ._ 5 2 SO ED -- --- — STREET (3) SECURITY NO. _ SECURITYAMT: SCLOSE SURETY CO.: _ ___ )NAL G,,, -/-�(i• _ CERTIFICDCHKCK I, CASH 11a0w C (4) PLOT FLAN: INDICATE SITE PERTINENT PHYSICAL z SPECIAL. PROVISIONS j CONDITIONS. FEATURES; EXCAVATION LOCATION AND EXTENT. Ll 1 ( 1 1 1 I (S) NOTE THE CITY OF TIGARD DOES NC,T, NERERY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE RIGHT OF WAY JURISDICTION IS THr.T OF WASHINGTON COUNTY OR THE STATE OF OREGON THE APPLICANT AGRLES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPL: WITH ALL PERIINENT I AWS AND CONSTF -CTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THF CI I-Y .AIJD EMPLOYEES AGAINST ANY INJ(.)13Y OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS APPLICANTS SIGN ATIJRE DATE _ �� S car 159�Sg � 1ST INi t it . lo --------- .x: _- W 0 > �` `-� m Q z w > r), W a I�-,�I n 111_JJ lY _� t V U co L- O w Q U) U 0 0 ~ � z '- Q o w raj O O z - I w z U JN Z Q r W ►- U ] Z U X w O LL.' 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