12878 SW VILLAGE PARK LANE l
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12878 SW VILLAGE PARK f.,N
CITYOFTIFAIM
CEk1 CUCANC OFOCCUPANCYCY
reOFYW4RD PERMIT H. . .. . . . . A BUP89224p
COMMUNITY DEVELOPMENT DEJ,"T [T oReda+ PRIM. P RMIT N. : 892242
13125 SW Hall Wed R0,Boy..23397,Tigard.Oregon 07''.23 (503)839-4176
DATE X 5SUED a 06/14/90
SITE ADDRESS. . . : IP878 aW V?.I...I_OUL PARK LN PARCEL: 15133DD--
SUBDIVISION. . . . e ZONINC3e
BLOCK. . . . . . . . . . : LUT. . . . . . . . . . . . . 197
CLASS OF WORK. iNEW �~
TYPE OF USE. . . a 5F'
OCCUPANCY GRP. eR3
OCCUPANCY LOAD+
TENANT NAME:. . . :
Remarks e
Owners
DUN MURISVETTE
PO BOX 19524
PORTLAND OR 00000-0000
Phone Me 000 000--0090
Contractor.-
PON
ontractor:DON MORISSE;TTL PLPERS, INC:.
P O BOX 19524
PORTLAND OR 97719
Phone #0 503-620-7538
Rep %. . 9 355:33
Occupancy of +;he above referenced building is herreby pivern, certifies
the coMpl ianct: with the {hate Of Oregon Specialty Codes for ►,Troup,
oc^upancy, and imp- under which the reference d permit was i,ssctrv.
FIRE DE:TAkI�ENT "ILDINO INSPE(;T
-;PR
BUILbIyfd' OFFI O'L -
I
DOST IN CONSPICUOUS PLACE
i
INSPECTION NOTICE
t
City of TiganI Building Cepartment
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested._._ �.� Time A.M. G�P.M.
Address ® L/L � '�' / u -�ermit
Owner_._ Lot #
Builder
The following Building Code deficiencies are required to be corrected:
V4
Presented to — proved
Inspector r ❑ Disapproted
Date
CALL FOR REINSPECTION
D YES ❑ NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. BoA 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection _—
Date Requested 92 �G Time � A.M. P.M.
Address y/ 72 Z)(.`.����A!– d��� ftrmit #
Owner Lot #t _
BuilderThe following Building Code deficiencies are required to be corrected:
17
Presented to —____— ❑ Approved
Inspector �1.�2_ J 1,(J oitepproved
Date ® —
CALL FOR REINSPECTION
-3 ❑ NO
S�
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 _��ll� -��-- �LAmit �s+
Owner �J (/ _ Lot #E
Builder
The following Building Code deficiencies are required to be corrected:
Presented to _ — __ Approved
Inspector ��� _ — --- ❑ Disanproved
— a
Date. _ !I —
CALL FOR REINSPECTION
❑ YES 0 NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone 639-4175
4
Type of Inspection CS PAC - -
Date Requested ���' TM A.M.__.-P.M.
Address APermit
n
Owner _ Lot #
Builder _ - �-
The following Building Code deficiencies are required to be corrected:
Presented to _ ri Approved
Inspector -��t s � A "' - I Disapproved
Date
CALL FOR REINSPECTION
0 YE8 I1 NO
INSPECTION NOTICE
City of Tigard Building Departmart
P.O. Box 23397
Tigard, Oregon 9722;
Phone: 639-4175
Type of Inspection
Date Requetted� Tinu A.M.
Cl000,
Address Permit
Owner
Lot #
BuilderS 2F,
The following Building Code defici,inchis are required to be corrected:
r-7VZq q,
'S
>k 4
4C
Presented io P (Approved
!nspector
5-7 Disapproved
Date 15?
CALL FOR REINSPEC770N
E71 YES FJ NO
1�
INSPECTION NOTICE
City of Tigard Building Department
P.O. E
Tigard, Oregon
97 9722.3
Phone 639-4175
ype of Inspection//,_SX _S
Date Requested Tim _ A.M. P.M.
Address 1�c`o i�__ � ° - Permit � -
i
Owner — Lot #
BuilderThe following Building trade deficiencies Fire required to be corrected:
- --�_'
Presented to ( Approved
Inspector ❑ Disapproved
Date
CALL FOR REINSPECTION
D YES ❑ NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection' — �—
Date Requested 4� -n ° A.M. —P.M.
Z1.
1 -
Address —Goad_ ----� � snit
Owner Lot
Builder ------`
The following Building Corte deficiencies are required to be corrrected:
Presented to Approved
Inspector �T ' -- Disapproved
Date ' — —
CALL FOR REINSPECTION
res 0 No
INSPECTION NOTICE
City of Tigard Building Department %
P.O. Box 23397
Tigard, Oregon 9722
Phone: 639-4175
Type of Inspection ,/ �'—�.� ,d'— —
i
Date Requested_ Time _ A.N .__x_P.M.
.1
Address #
Jwner ______ Lot #_
Builder ---
The following building Code deficiencies are required to he corrected:
i:' -�L-'— - ��� �•
i rte.
Presented to _—_ _ y�Approved
Inspector ❑ Dlapproved
N
Date - l
CALL FOR REINSPECTION
E] r-a D NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639.4175
Type of Inspection —sem G�'� It--
Date Requested_�_� —4�
Address 42 7 .�.a v /y/ Permit
Owner Lot
BuilderThe following Building Code deficiencies are required to be corrected:
Presented to _ --____w P-Approved
Inspector —___ ❑ Disapproved
Date -
CAI V FOR REINSPECTION
❑ YEf ❑ NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phore: 639-4175
i
Type of Inspection
Gate Requested / �� LI I Time A.M. P.M.
Address _ f� 7� 11'�s /76 Permit
Owner_ _ Lot #
Builder ---
The following Building Code deficiencies are required to be corrected:
vt
L S S t t'i 4 —
� _J Al 15
-r-Q
Presented to -Approved
Inspector Disapproved
_ , aA �e
Date
CALL FOR REINSPF,CTIO.:V
❑ YES F- NO
INSPECTION NOTICE
City of Tigard Building Depart
P O. Box 23397 \ \
Tigard. Oregon 9722.3 \ J
Phone: 639-41 \,y
Type of Inspection
Date Requested � Time_ A.M. P.M.
Address /c � ��LI'J. �G �— Permit #
Owner _ Lot #
Builder—
The
uilderThe following Building Code deficiencies are required to be corrected.
/
Presented to ----_— __---_ _.. Approved
Inspector _ _ IV,
Disapproved
Date '�y. _----- —
CALL FOR REINSPECTION
/ ❑ NO
INSPECTION NOTICE
City of Tigard Euilding Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested. �� y� Time "D A.M.. P.M.
Address �.a d5� & ik� Permit #
12ayz
Owner Lot #
Builder —`- ,-- ---
The following Building Code deficiencies are required to be corrected:
t
T
Presented to _ =�L! Approved
�7 ❑
Inspector Disapproved
-.¢°— - --
Date
CALL FOR REINSPECTION
❑ YEa ❑ NO
INSPECTION NOTICE
City of Tigard Building Departm
7 r P.O. Box 23397
J Tigard, Oregon 97223
(' Phone: 639-4175
Type of Inspection ---
Date RequestedTi
me
`` / � A.M.-----P.M.
Address —L` - 2ry 01/—T<<C'-'e Permit
Owner Lot # _
Builder ---
The following Building Code deficiencies are required to be corrected:
i
Presented to Approved
Inspector _� L -- - -- _�. Disapprover)
Date — — -
CALL t: REINSPECTION
YES (_l NO
i
w N W W ouw—Lwzw— oR—IMMM
8-03'.L.[):IN(.,# PI-JIMIT
0F.JIMTT NO. : 18111,J092242
CITY OFTIFARD CITYOFtWAV
ITY
COMMUNITY DEVELOPMENT DEPARTMENT 0420001 1 1/90
11125 S W Hall Blvd.P.O.Box 23397,Tigard.Oregon 97M.(5031639-0175 C
,K)U AIJUIA-:55 : J.P078 SW VJ:I LAGE PARK LN
I AX MAP/1-01, 3.451 33DD SUD: VTL..L.A(,E!. At 5UMME-J4L..AKF'-: 7-2 L-T 61 HK
L..AND USE: P41.,5PD
I. ('111 5 1:ZF VAL-LJA*7T0N : 1:11.5 ,020 !-&A HACIKS
FRON1' : "r_'.0 REAP 6
WORK (,LASS : NEW DWELL .UNITS LEFT: 10 P1('.-'H1" : 3-Irl
1151 TYPE : .FPJN(XX: FAMI.I.-Y W.). FX*.'DA(X.')1`1!; : A EXT .WAL.L. DONS T :
(MINIST . TYPE: VN NU. BATHS : 1 N. S : E W
W3 PRO T ,OPENINGS
(](:(:IJP.LOAD N 5 E W
TOTAL.. AACIA : P 5.15'.'5
NO. STOFIXES : a IST : 11419 ROOF' (:',ONS'r : F IRE RET7
PP 'ND 1410/1 AIFOKA SEPAP?
BASEMENT? 3RD: OU'UP. SEPAP7 PA'rEU:
MI-:.ZZANJ*Nr-*.'.? VIA51:KM' T
FLOOR LOAD: (40 433 F1114E SPAKII P? ALARM?
F L.0 IAI l G1-:'M> 1.)V 1'E, I'I? y E.5
14P-A-1- :EYWP UAS MIX1141 All""illi
I,L.AN (A-11ECK I:J't
REMARKS :
PFUSSUE OF NO .
LAST REISSUE
F.r E'L.
0
W MOR195SETTE DON PF-JIMIT 11111473.00
N I:)I-AN PF-.:VJ+-W $307 .45
E
p ti r t'l.PL n(11 tar FIRE DEFT
1:VY'ATR 'I AX *PZ5. 65
OTHER
C .)Fi.UF--L..OPME.N'T LHAVK-EL) :
O MORI.-iiiji-1-1-E DON SM.(15'ropm) t4250 .00
N
T L)('.)N MOPTY:4: 1-11V VX1.11*1 DERS I M' ci EX,(S 1,AFK E t 11 4;el 0 0 . 0 0
R $250. 00
A PC) HOX 19524 PPEPA]"D <
C I:)ni-t1nnd 97219
T
0 PHONE 111503) 2441-93141
R I'HJ.TS1'PAT:L0N ND 315533 AL.. : $1. "641. 1.
This per-nit is Issued subject to the regulations contained in Title 14 RECEIPT NO. /(J C,
.................................
of the TMC, State of Oregon Specialty Codes, zoning regulations
and all other applicable codes and ordinances, and it is hereby 1EQUIMED I.NSPEC11JONS
agreed that the work will be done in accordance with the plans and F'001 :11 N(; C.')E W E,P
specifications and in compliance with all applicable codes and FrOUNDA1JON WAL..L PAIN ()RAINS
ordinances The issuance of this permit Joes not waive restrictive POSJ' & r*...AM WA1F.44 I...I:Nl::
covenants Contractor and subcontractors shall have current city PL 8 . UNDE*14SLAB CITY APPP(,H/SW
business tax permits This permit will expire and become null and
void if work is not started within 180 days.or if work is suspended or SI. AH F T NAL.
abandoned for a period of 180 days any time after work has PLIC . 'TOPOU1'
commenced. It shall be the responsibility of the permittee to assure FPOMT NG
all required inspections are requested and approved F I PEPLINGE
(3A5 1-11NIF
]INSUL-ONTION
�yl:) 130API.)
Permittee Signature
Issued By, FOR
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
C17YOFTIFAFILUMBING
RD &%ftt' P1.-::PMT'Y' NO . PL.89P.398
CITY OF 1`16ARD
COMMUNITY DEVELOPMENT DEPARTMENT
13121,SW HAUBlvd.130 Dox 23397.Tigard,Oregon 97223.(503)639-4175 1/1.7/90
PQIM PMI'
JOU ADDRESS : 1211378 SW VILLAGE PARK LN
'Tox MAP/1 OT :I.5 J.33 Dr.) SUB: VTLl..A(.A:'. Al SUMME.-PLAKE:': V'APK PH2 L_1 e, 1. HK
L.AND USE : PIPO
ITEM: NO : NO:
WORK 0 ASSi : Nl*-.W Wo TV,1') CLOSET 3 TPol.-,
USE TYPE: SINGLE FAMIL.Y URINAL RKF*1 OW 1:-'I:IVNI'A
CONST . 'I Yf:,I.:: VN I..A1.10PAII)PY .3 1 1:4AP P P 14 1,M L,1:4
UCCUP.GPP . R3 TUB SHOWER 3 GPEAiE TRAPS
DISHWASHER 1.
('.vAP8AGr.-". DISPOSAL I
NO . 5*T'0r-4:EE!:i : P WASHIN(*., MA(.'>-1J.'NF I
DWELL .UNITS : :1. LAUNUAY TRAY W1.-D(. . 1'.)PA1:N (DIA
F L 00P DRAIN
..iINK I SF:WP.:*P (FT)
WATF;-'P Ell 1. !.i.10PMMAT'N l"T I.
OTHER
01 MAPKS :
0 FEES :
W M�31:41 S SETTE DON PEPIM11
N p I:) DOX 1.95f-?z4
E
R p cl 1 1;1.114:1
STATE: TAX $ 7 00
OTHER
C
0
N
T
R
A
L(
R) PE(.,:I*1i1PA*TA.('.)N NO. 1111111-17 . 00
T his permit Is issued subject to the regulations contained In Title 14 PF.T.EIPT NO.
of the TMC, State. of Oregon Specialty Codes,zoning regulations
and all other applicable codes and ordinances, and 11 is hereby R�-"111.11PL-A) INSPECTIONS
agreed that the work will be done in accordance with the plans and V-11 8. UNDEA451.A8
specifications and in compliance with all applicable codes and POS T' & REAM
ordinances The issuance of this permit does not waive restrictive WA1144
covenants Contractor and subcontractors shall have current city
business tax permits This permit will expire and become null and P1 8 . TOPOU1,
void if work is not started within'180 days,or if work lessuspended or PA IN DPA INS
abandoned for a period of 160 days any time after work has F—INAL
commenced It shall be the responsibility of the permittee.:)assure
all required inspections are requested and approved
�
x-�Vt*v"-
'rmi Ilea Signature
Issued By, TISIF-MEM 10W
SEPARATE PERMITS REOUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
M:'GHANICAI... PF:PMT 1
CITY OF T167A RDc1:1-14111:11' NO . : ME'.89P399ITY01FIrIGAra
COMMUNITY DEVELOPMENT DEPARTMENT oploom
13125 S W Hall Blvd,P.O.Box 23397,Tigard,Oregon 9722.3,(503)6394175 DM 1::: T ISSLA:1.) :1 1 90
IQ P
%.JOR ADDWEISS : 'U.-28714 SW V11 LAGE PARK LN
TAX MAP/1. (:1'11 1.!i)1.3*31)1:) Al tit-IMMki-PLAKE. PARK F)H2 L'T 6.1. L::K .
LAND (JFiE: P*711-j1)
LOT SIZE .
1'TEM: NO: N()
WOWK ('A A Li 5 ; N L'W FUHNA(Az' <1001K A34-4 1-1 .NDLW (1.0
USE TYPE: t-*s:[N(;L..I.'-' 1:-*'AM*.r.L-Y FURNACILK 1001<4- I AIR HANI)ILP 10K
VN FL.00114 F1.JHNA('..E F:.
VAP VAP GOOLEA
OCCUP.GPP. : P3 H E A 71-14 VENT FAN �
VF'N I VC'.N'T . SY51[-.'.M
13LP/COMl:-*' <311-413 HOOD 1
NO. 51'OPIES : R BLP/CIOMP 3-4151-41::' INC I NEPA'TOW(DOM
DWELL. .IJNI*TS : I 8L.R/COMP 15-3011P XNCINE-.'PA*T00(COM
'(*YPI::-
HLAI/COMP 30....50M., UNJAS
MAX . :1N;)u'r BLP/COMP 50+1-1P (]THEP 2
I'-* :rr4E L)IMIPP57 F:,]*V,'.I:N(., OUTLETS 1.
HIGH PRE SS7
I L-11W PWF4;;4;'Z
REMARKS :
0 F:'EES :
W MOP1'5!iET71--- DON PEPMIT $11.0 . 00
N 13(j ROX 1.915P/1 P1 AN Pl':'V:1*1::*W $1,
E
R Portland c31^ I FIXTLJPE ; *X5 . 00
5*1'0'1 F AX.
011-ir-ER
C
0
N
T 81-A...1... HV:A'T'*1:N' INC .
R
A 1.55.509r-': P*l:AZZA AVE
C (.'l-A('.,KAMAS (:1R 9 7 0 1.5
T
0 PHONE (503) 2413••••i.1.F:14
R Mi'(.415.T*r4A*I'T(*)N NO , d441-7 '1'(:)('At $11-Al 50
7 his permit is issued subject to the regulations contained in Title 14 MA E I PI NO .
of the TMC. State of Oregon Specialty Codes,zoning regulations
and all other applicable codes and ordinances, and it is hereby REQUIRED INSPEC'TIONS
agreed that the work will he done in accordance with the plans and (.,M; LINE
specifications and In compliance with all applicable codes and PMT & BEAM
ordinances The issuance of this permit does not waive restrictive POLKAI 3:N
covenants Contractor and subcontractors shall have current city
business tax permits This permit will expire and become null and FINAL
void if work is not started within 180 days,or if work Is suspended or
abandoned for a period of 180 days ary time after work has
commenced It shall be the responsibility of the permittee to assure
all required Inspections are requested and approved
Permittee Signature
Issued By F-01PF.C.'I TON 83 7--ri 1. 7 IM
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
SEWEP V'ERMT I'
PEKP141'r NO. : SEF E99CITY OF TI67ARD (C"YOrTWARD
COMMUNITY DEVELOPMENT DEPARTMENT DATISSUED: 1/1.7/90
13125 S.W.Hall Blvd.,P.O.Box 23397.Tigard,Oregon 97223,(503)639-4175 �)7� E
P141M. PMT .NO . 892242
JOB ADDRESS : 12F178 SW VIA-1 AGE PARK LN USA NUMBLP: 3917,".11
1 AX MAP/1-(:11, 1511:1;3:31:)[11 SUB: VILLA(*.�,F.. AT 5UMMERLAKLi.: L.T : 61 HK :
LAND USE : PA . WD
1.01 %:1:Z E::
s33
F.-cTION: PNG; w
WORK (11-ASS ! NEW
USE TYPE : SINGLE FAMILY
with) 1.113. r'I'llevi itirld I•eiclulattinnn; n-F the Uni-Fiect
Ths.e permit expir-evi 120 (layu; -121-1:11n thvp OaLte i%suir(J . The tc)till
iunlQltrlI. p'li.J.(1 W-13,.1, L)e.-� •1'rir T ioi ted :1.f thea I.)(a,I"Mi t IF.!A 1:).i.I" IC: A(.1 e I-I C.y d C)e 1:i 1143t,
iantee the &(::CIuI--IV::!y OF the 1.c1clat-.1.un Of the lllidcx iaewer :l ca t.c�ria].9► . If th(.-:! iiiewwi, J.%
III-it i;IA the the J.11iritulliver sthaLl.l. pl-c)%pec't 3 f ci?e t j.I I
is.11 clirectiunsq fr,nin the clisitatnce given . If nut m43 locattacl , the iniatailler shiall
Ili;.)Iiica ri. ''Tial) iallcl 5:11ie Sewr.-.vr"' Pii�omit atrid the Agency will inrAtull Ill. lat"i-ial-
INSTAL.L. . TYPI--- : IMPIE-:11VIOUS AREA:
1; IXTUPL-i'. ILINTI'!:i : 1'1---'NAN'I' TMPWWEMENT :
DWE-1.1-ING UNITS . :1.
OF, 91-DW-1 .1
0Mor;I DON PER1,11.1 3b 0 0
W
N p o BOX 1195211 CONNECTION CHARGE
E
co r t'l.I%.#.n cI 1311 I-INE TAIJ TWO'Al L. .
OTHER
C
0 M(,)I:I:r 515ri'l-11�. DON
N
T DON MOPISSETTE BUILDESIS 'I:N(:, .
R BOX i9bpdl
A
C PartInnd ur, 97219
T PHONE: (!-303) ;)AZI-9314
0
R RE-i-l",ISTRATION NO. X)!533 TOTAL : 11111. 205, UU
This permit is Issued subject to the regulations contained In Title 14
of the TMC, State of Oregon Specialty Codes,zoning regulations
and all other applicable codes and ordinances. and It is hereby
agreed that the work will be done in accordance with the plans and POUGH IN
specifications and in compliance with all applicable codes and
ordinances. The issuance of this permit does not waive restrictive
covenants Contractor and subcontractors shall have current city
buelna,-s tax permits This permit will expire and become null and
void if work is not started within 180 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 inspections are requestc 1 and approved
tee Signature
Issued By11 -111ti tl-T-T-TTW. 6 15 1
—)I"* TTii
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
; y� � PLAN (�iECK APPLICATION
cITY OF T16rARD �oFi1GAID PLAN a(ECK a -
PERMIT (f �. : 1. �=
EVELOPME"T DEPARTMENT DATE ISSUEO -
COMMUNITY O srm.cs*314MA'rs _
YAX MAP/tOT
2£� 1�i .�� 11 i���a G Q �►��.k LN__ ----- LAND USE:
7013 ADDRESS: I -OT
!Wo: unl(!( AT Cv.
....;� LOT: ��1----
VALUATION: _ ^�-'-- -�� c-"�-- SPECIAL NOTLS
'u REISSUE OF: ---
OWNER `,�,�D 2 t 1.�--------`- LAST REISSUE: ----
NAME: FLOOD PLAIN/
��!IORESS: - C/ VE LAND:
--
SENSITI
APPRUVALS REQUIRED -
PLANNING:
0ONTRACTOR ENGINEERING:
NAME: ----- ------—
--- FIRE DEPT
.
AODRESS: _ OTHER---------- RS:
THER: ------
_-----'
----
LIST/St1Q(70fUTRA�'TORS:
P11ONE -.
BUS TAX: --_-____----------
ARCH/_ E_NGINEER CALCULATIONS: _----
TRUSS DETAILS:
PARKING PLAN:
ADDRESS: ------� - _-_----- LANDSCAPE PLAN: _ --
__�.- ------
OWER' ____ -------_ - --
PHONE: -
comcNTs: t�I S S 4e �, Y N _------ --
AMOUNT AMOUNT PD. GAL. DUE
PERMIT N ACCT'H DESCRIPTION - ✓
Building Permit Fees --
10-432 00 _----- ---------" � "-
� 10- 431 00 Plumbing Permit Fees
��_��•�c Mechanical Permit Fees
f 10-431 Ot
`----
10-230 01 State Building Tax (57-) ✓
Quilding ^+p
P 1 u mb i ng
moch
10-433 00 Plans Check Fee V�
Building _--
P 1 umb i ng -__-_-
Mech _-_--
30-207 00 Sewer Connection -----
ic, �
30-444 00 Sewer Inspection
Street .;yst-em Bev Charge
51-448 00
52-449 00 Parks System Bev ry'arge (POC) ---
31-450 00 storm Drainage Syst Dev Ctirg (,SOC) _ -
10-7.30 09 TRFO
IO-2'30 06 Ldashingtc+n County Fire at (95X) - 60
10-720 00 nmart/Wedgewood
TU1AL \
RFC 11
,
nPPt-ICnNT S1GNnTURE
()ate Received: --
Received By:
co/3587P/18P
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