13515 SW 72ND AVENUE ADDRESS:
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SITE WORK
CITYOF TIGARD
*Ai�
RD F"E RM 1 T
COMMUNMY DEVELOPMENT DEPARTMENT -,E RM I T #. . . . . . . : S I'r 9&-,--0007
13126 SW Hrl Blvd. P.O.Boat 23397,Tipud,Orpon 97223(603)6394176
SITE ADDRESS. . . : 13515 SW 72ND AV
PARCEL: a`S 101 DC.- 1710:,c•1r;,
SUBDIVISION. . . . : ZONING: C-P
BLUK. . . . . . . . . . . LOT. . . . . . . . . . . . . .
TYPE OF WORE:ADD PAVING?. . . . . . . . . :N RESO. NO. .
E.XC:V VOLUME. : cv GRADING?. . . . . . .., eY VOL UE. . . b : i
FILL VOLUME'. ::200 c y LANDSCAPING?. . . . ..N
ENG FILL?. . . . . . .N SITE PREP?. . . . . . :N
SOILS RF'T REQD?:N STORM DRAINS?. . . :N
IMPE:RV SURFACE. . : s; 1=
nets—ks : Adcl appr:)x 200 yds: fill for, add' n to parking lot.
Owner.: _....____________....__-------..___ ___._.___.____..--- ---_.__.-• FEES
ME BRITT MONSON type ama�.tnt by clat9 r^ecpt
56'74 SW CI-IgRl-.ES CIRCLE PRMT $ 36 00 JI_H Q),4/06 9a? ���5
.
5PCT $ 1. 65 JLH 04/06/92 225
I-ARE 013WEGO OR 97035
h'I�fJnp #: 684-5777
contractor:
CONTRACTOR NOT 01\1 FILE
Ph on y # ,: f 34. 65 'TOTAL
Rena fk. . .
_______ REQ' 'I RE D INSPECTIONS
-
This perait is issued sub.iect to the regulations contained in the Erosion Control
Tigard Municipal Code, State of Ore. Specialty Codes and all other Fill Ins:pec'tion
applicable laws. A.? work wall be done in accordance with Grading Ins;p
acproved plans, This perait will e-oire if work is not started Final 1 n s Fier-; 1 on
within 190 days of issuance. or if work is suspended for sore _._,�__ .M_•____ __. ___� �._..
than 190 days.
i-Nr•mittFe Signatltro :
�1'I 1100
Cal .1 for, inape(.,tion - 639--4175
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13125 SW Hall Blvd. PLNCK/RECT # 4-59
CITY OF TIGARD Ti POBox
23 97:23 PERMIT # -
COMMUNITY DEVI?LOI �if:N'1'DEI ARTMENT'
(503)639.4171 DATE ISSUED
JOB ADDRESS: S j� TAX MAP/LOT
SUB: LOT: LAND USE:
VALUATION:
OWNER , I SPECIAL NOTES
NAME: MG L1� I 1� UNS� /�� REISSUE OF:
ADDRESS: G�7 S w �1 } -1�-5 C l e-CL-f, LAST REISSUE: _
C-; Cl'�U e-GQ , UIQ 9 -LL) ';— FLOOD PLAIN/
PHONE: - 'KL4 '?gZ of:f- LL - S777 SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: _ _ PLANNING:
ADDRESS: ENGINEERING:
FIRE DEPT:
PHONE: OTHER:
CONTR. BOARD #: EXP DATE:
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: _ LIST/SUBCONTRACTORS:
MECH: BUS TAX:
ARCH/ENGINEER CALCULATIONS:
NAME: _ __ TRUSS DETAILS: _
ADDRESS: OTHER: _
PHONE:
PROPOSED BLDG. USE: r�N�a c:1 rc�n7 '7� ,�(iL�,zzit✓,4.4 -/�/'l'Z�A' �(s-L)y S
COMMENTS:
C_.
APPLICANT SIGNATURE
Received By: _ Date Received:
PERMIT # ACCT # DESCRIPTION AMOUN�Ty� AMOUNT PD. BAL. DUE
10-432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees _
10-431 01 Mechanic,? Permit Fees
10-230 01 State Building Tax (5q) , 65
Building
Plumbing
Mechanical
10-433 00 Plans Check Fee
Building _
Plumbing
Mechanical
10-230 06 Fire
30-202 00 Sewer Connection
30-444 00 Sewer Inspection
25-448-02 Commercial TIF Fees
25-448-04 Industrial TIF Fees
25-448-06 Institutional TIF Fees
25-448-03 Of,'ice TIF Fees
25-448-01 Residential Traffic, Fees
25-448- 05 Mass Transit TIF Fees
52-449 00 Parks System Dev Charge (PDC)
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC)
24-445-01 Water Quality (Fee in lieu of) _
- 24-445-02 Water Quantity (Fee in lieu of)
TOTAL
nm/3587P.WPF
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