11490 SW VENUS COURT-1 f
cILE NO.
VENUS CT. -- 11490 STR. OPN. PERMIT
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Cr17 OF T.CCAM)
EXPENDl'IURE .RBDUESI'
'this form is a multi-use form. Appropriate receipts must be attached. DocLmwrnt-.ation
i_, iuTx.rtant for all pw.poses. Staple documentation to form.
VENDOR NO. : _ DATE: Z- - -9 1_
PAYABLETO: I ��v�e,�n � RK2(=TD BY: _
reeve vera ___
i o 2 01, Approved request due Wednes ay
10:00 AM to A/P for cbecks by
Friday.
MISCELLANEOUS EXPENDITURES: --
Date Description, Invoice No., etc. Aooaunt No. Amount
-assura&Ace Q .-ZZ000 SOO o0
TUrAL CIO
LL
ec �DOIU531'] �z�i3 _
Mileage $0.255
APPROPRIATION BALANCE: _ AS OF: SI�dATl1I2F:
(Up to $25.00) Section Manager Y Purch. Agent
($25.01.-2,500.00) Division Manager
($2,500.01-7,500.00) Dept. Nead
($7,500.01-15,000.00) city Administrator
($15,000.01- ?) Lix--a1 Contract Review Board
ke/1501-'
T.erse C-kk CL,-A,
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APPLICATION - STREET IMPR�" --MENT/EXCAVATION COPY TO:
ORDINANCE NO. 74-14 (WHITE)-FILE
(YELL-OW)-INSP.
(INSTRUCTIONS ON SEPARATE SHEET) _J (Pll K)-O7HEI3 AGENCY
BLUE)-APPLICANT
APPROVED �f
APPLICATION NO.: %586
6
NOT APPROVED ❑ CITY (;F I'IGARD OREGONo —
FCC AMT.: S __ J.;I
PENDING FEE PMT. 0 (JTV HALL a$k3 / J
ECE�T NO.: I /
PEND!NG SECURITY ❑ PUBLIC WORK:DEPARTMENT BY _ /3'
DATE_ ri
PENDING AGENCY "OK" [] Application and Progress Record _ — — — — — — — —
PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATI-IN MAI ASEREQU REDOND •
PENDING VARIANCE ❑ ANNUAL
EXPIRATION DATE:
PERMIT NO. _ - _DATE IS'UED _ _ /5 BY _
(1) APPLICATION 13 H�REBY MADE TO EXCAVATE FOR AND INSTALL � pproac:
_SIR�\ 216,—_ AS DESCRjIBED HEREIN, IN FULL ACCORDANCE WITH PTY REQUIREMENTS.
APPLICANT r"w, U. - S `TQC\ [ Q �;tj`1.1 (1(r��
AM ADORESf � f
CIT PHONE
CONTRACTOR �Pf �C (L 3 rS UJ. SJp �dti {--0Qr' � �r �Cz
NA AObR �� � /•
HO
PLANS BY CITY
-- NAME I�71 D1� CITY.,-__
I NONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S
OLLARS
2) EXCAVATION DATA: �� .- _ Fo►, oFflcc use
CITY OF TiooFr, NT PEC fli): 0 105 1
17 H N:.C. A110UN I' "12. 00 II
NAME TIGARD AL.(I..,NMEPJT AUT 0 024bH AMOUNT
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RjFt,PnSF*.' nPA,MP.JlT AWN INT Pif D PUF:470SE OF AMOUNT FAT D
7.G Ci. 0 0 PUMA(.' fMF,FC)'.'EtlEN'*r Ft--.Prtv's
(;l.lc3T0Mf'.R DEPeSITS
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