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15979 SW 72ND AVENUE rrD " e SW 7jX •� 4 a ' T ♦r � 5 r CRYOFTIGARDPLAN CHECK APPLICATION TCC:fffl . COMMUNITY DEVELOPMENT DEPARTMENT �ARE, PLAN CHECK # c;- c�.3t3a-15SW .18W. P.O,Box 2M97,r oH I PERMIT # (' MP+�^i.Oregon D72s3(.5a3)&V4175 � 7 >`1 \� DATE ISSUED JOB ADDRESS: I ^J 7 _ TAX MAP/LOT SUB' LOT: LAND USE: OWNER VALUATION: — SPECIAL NOTES NAME F'A C;T2�> T REISSUE OF: ADDRESS: /// S ln/ 57 7 ii�O ti LAST REISSUE, FLOOD PLAIN/ PHONE; — SENSITIVE LAND: CONTRACTOR APPROVALS RE UIREU PLANNING; NAME: %�_ ,�.- GR-�/t/ p , - --- Slni �� Lh Q✓ C- , y d/ l� ENGINEERING: , ADDRESS: f '-r� •) FIRE DEPT _ OTHER: PHONE: - ITEMS REQUIRED ARCH/ENGINEER ,c LILT—/SUBCONTRACTORS: NAME.: �i l(%�Gr/ `�' 2s�v1�`/ 4 BUS TAX: CALCULATIONS: ��. ADDRESS: ( K_^J 1DC <, r TRUSS DETAILS PARKING PLAN: PHONE: LANDSCAPE. PLAN: — L� l-�- ,� OTHER: - COMMENTS: PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE 10-432 00 Bui-Jing Permit Foes 10-431 00 Plumbing Permit Fees - - _.,, 10-01 01 Mechanical Permit Fees - - 10--230 01 State Building Tax (5X) � Building <f, - Plumbing Mech 10--433 00 Plans Check FeeAj3 Building _ _ -- Plumbing Mech 30--202 00 Sewer Connection _ 30--444 00 Sewer Inspection _ 51-448 00 Street System Dev ChargE (SDC) J 52-449 01 Parks I System Dev Charge (PD(':) CO 52-449 02 Parks II System Dev Charge (PDC) - 31-450 00 Sturm Drainage Syst Dev Chr•g (SSDC) 10--230 09 TRFD 10-230 06 Washington County Fire #1 (95X) 10---220 00 Amart/Wodgewoou - TOTAL A REC N j,Qy2y APPLICANT SIGNATURE / -- Received Ely: c / .�C, --- Date Received: �, �., l ht/3587P/iWP