9648 SW WASHINGTON SQUARE ROAD I
ADDRESS:
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CERTIFICATE OF
CITY GF TIGACCUANCYIRD PERMIT 0.. . . . . . : BUP94-014
COMMUNITY DEVELOPMENT DEPARTMENT DATE I SSUED t 08/16/94
13125 SW Nal!Sivd, Tigard,Orapon 97223.8199 (503)E39-1171
PARCEL t 181►60C t�1 10
'.'I TE. ADDRESS. . . : 01648 SW IAHSH I NG TON CiGIUORE- RD 016-15
,-,UND(VISION. . . . : ZON I NG i C-0
BLOCK. . . . . . . . . . e I_UT. . . . . . . . . . . . . s
CLASS OF WORK. t ALT
FYPIF OF 63)E. . . ICOM
OCCUPANCY GRP. %82
iCCUPANCY LOAL07
rENANT NAME. . . :
Remarr•kst Friedlander Jewelers--• tenant modification
Owner: _ __.... __.__.___.....___._.__ . ....._.
W I NMAR--CASCADE INC
'00 5TH AVE. * 600
EATTLE WA 98104-56Z6
i_1hone #2
uittractort
i3LC)ENE CONSTRUCTION, INC
PO BOX 1353
i.YNNWOOU WA
t,horse M t 206-774 -31165
irrq 4. 01 636,50
Or"cr.lpan;,y of the above referenced building is hereby given, and certifi--
trhe compliance with the State Of Orepon Srer.ialty Codes for the group,
.�rr. 1.ilpancy, and use under which the referenced permit was issued.
DING NSPECTOR
.._....�..___ � BL'It..DI 1 ICIAL�..w_.__. -- -
POST IN CONSPICUOUS PLACE
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IN1PtCTION NOTICS
City of Tigard Building Depart:ent
13125 eM Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec Phone)1 639-1175 Business Phoner 639-1171
c'
Inspections___ -
rooting Plbg. Underslab Hoch. Rough-in APer/sdwlk
round- Plbg. Top Out pas Line ` rINALs
Post/Beam strum. sin. S-ywer Framing
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Rd.
C
Date Requuestbt / Tunes �11M CPM
Ac'dry as�y� '` �,��iY_ Permit 11�11q�� J
9jild.r. ('0 M -CO 2 l
TRE FOLLOWING 'JORRECTIONS 11RR RF.Q111RP.D:
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r 1►PPRt1Vwn DISAPS'"Man APPROVRO S"lLtRCT Tb ANOV2
_Call For Relnsp.
�SPECTIUN NOTICE �"�_/
City of Tigard Building Department I
13125 RW Hall Blvd. Tigard, Oregon 97223
Inspection Lina (Rec-O-Phone)t 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Underslab Poch. Rough-in Apps:/sdwlk
Found. Plhg. Top Out Gas Lina MALI !
Post/Beam Strut. San. Sever Framing -Bldg,.
Post/Beam Koch. Rain Drain Insulation �. 1
Plbg. Jnderfloor Nater Line Gyp. Rd. -Noah.
Date Requests/dt ` L/- 9 TLmot
Address t LA C.,, CSC Gj Permit!t
Builders
THR FOLLOMING ODPRECTIONS ARE REQUIRED: II C
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Inspectors ✓ Datet- O/�
ntSRPPROVRO APPR("O StlBSEtT TO ABOVE
call For Reinsp
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CITY OFT IGARD
�
COMMUNITY DEVELOPMENT DEPARTMENT
13125 S*Hal-Blvd.Tigard.Oregon 177223.8199 (503)830-4171 PLUMBING PERMIT
PERMIT M. . . . . . . : PLM94-0124
639-4171 :_IATE ISSUED: O6/30/94
PARCEL: 1SI26OC -01107
SITE ADDRESF:. . . : 09646 SW WASHINGTON SQUARE RD
SUBDIVISION. . . . : ZONING: C—G
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . :
--------------------------------------------------------------------------------------
CLASS OF WORK. . :ALT GARBAGE DISPOSALS. . : MOBILE HOME SPACES. :
TYPE OF USE. . . . :COM WASHING MACH. . . . . . . : BACKFLOW PREVNTRS. . :
OCCUPANCY GRP. . :B2 FLOOR DRAINS. . . . . . . : 1 TRAPS. . . . . . . . . . . . . . .
S"rlRIES. . . . . . . . . I WATER HEATERS. . . . . . : 1 CATCH BASINS. . . . . . . :
ti. URES------------- LAUNDRY TRAYS. . . . . . : SF RAIN DRnINS. . . . . :
SI NI-. i. . . . . . . . . . . URINALS. . . . . . . . . . . . . GREASE TRAPS. . . . . . . .
LAVrTORIES. . . . . : 1 OTHER FIXTURES. . . . . :
TUB/GHOWERS, . . . s SEWER LINE (ft ) . . . . :
WATER CLOSETL. . : 1 WATER LINE (ft ) . . . . :
DISHWASHERS. . . . : RAIN DRAIN (ft) . . . . :
Remarks:
Owner,• F---- -- - ---- ------ .....--- ______--___-------------- -- ------------
FRIEDLANDER' S JEWELERS type amount by date recta'
9646 SW WASHINGTON SQ RD PRMT $ 30. 00 JG 06;30/94 —
PLCK $ 7. 50 JG 06/30/94 —
TIGARD OR 97203 SPCT $ 1. 50 JG 06/30/94 —
Phone Mc
ContTact or: ----_____---.-----__--___--------
MSI MECHANICAL
9655 SW SUNSHINE CT #7OO
BEAVERTON OR 97007 ----------•- --________________..___----
Phone N: 642—IE34 ! 39. 00 TOTAL
Reg M. . : 70032
---- -- REQUIRED INSPECTIONS ---- --
This ptrait is issued subject to the regulations :ontal,ned in the Top—out Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in accordance with
approved plans, This persit will expire If work Is not started
within 180 days of issuance, or if work is suspended for sore
than 180 days.
Permittee Signatures
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Issued Byll
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W Call for inspection — 639-4175
CITY OF TIGARD PLUMBING pLUZ SW� al
Appli anft must hOW Oxon Re0stratlon to conduct a plumbingowPERMIT Vk� LP 97?297223propene
business or ttwst be owner/operator toperator not Nri m W help. 6•r_},U75
Nanta of Oevemprillm
Plumbing P
Address ermit No.
.,oa sw lJ s!, rFIXTURES
Tax 1.01 21-610 CUAN. PRICE Afrtl
Address kup•No•tai Stock suoeirtsion
A+1•
Sink —7.50
a nam• sineas
Lavatory 7.50 75-el
ess tub or TubGhow•r Corny. 7.80
Owner ----- Shower Orgy 4 7.50
t• $ Water closet
/ 7.50 .7 5T'
Dishwasher 7.50
Phone -- •-
Garbage Disposal 7�'
Nam _ Wast"Mao-ow 7.50
Floor Oran+ / 7.50 7
am ptS
np res _
S WQC ,SWalerHeater e,>( '1.50 rt,
Occupant
City/SWIG zip Laundry Ra,m Tray �-
7.50
Unnal -- 7.50
Y J Other Fbrtur•a(SQ") 7.50
7.50
Contractor / -- 7.50
C Q 7.50
MISCELLANEOUS
CRY aw:To No.
7 , ;WlaktwW
to too _ 30.00
( � o to �. -.a.Addlt.100-
� 4{ Servlm t a 100' _ 20.00
I hereby t haw raw ria•ppYca ion•OW the WAwm*om Water S•rA=•a,Adat20D' t a.ao
haus a stat. "'ate�,nt•sut•Q•Board.and �,n A Pein Drain t a-t00• 30.00
Pk.ttbtnp tiwnee tear 1a rxrrttb•r>t
pkgr+bing work wi be done in 400ordanos with applicable provisions at Ore Storm i P yn Drain Addlt.100•
yon Res evisStsans Chapters w 7 and tlli 3 and appacabl•oohs and that 15.00-
-
no Mb wilbe—0010sd iffft a wood under ORS en(fl exempt hem MobdM Horne Spew 28.00
Stan regiwatinrt,Pisa••plus reason below). Sea Flow Prevsrom —
HOMEOWNERS-t hereby certity•at 1 am t'a owner Of the WW"do. MAO*or Ant-PokiamDev6m 7.J0
aci5•C above.a(Whbh location i propose to maks a pka,d* kt•taaadon for
my own urs sM MNa prapsrty M rtes b•liw oprtstr�plsd lo►aaN•tease tx rent Any Trap or WaM Not
Co nocledlo dt PdrWre ?.SO
— — Casoh Basin 7.80
- _- tiP.of Elm. 40.00 Per W.
\ %%*dohs PAqnaled
Agarof
t�du^y eieo .tiMta 15.00 nwt.
AUT11URVED SK)MATURE Dae Naw Bldg a BuMd.Aadadn
28.00 rm.
DO*Cnbe wor* new[] &Mition[] ellerttbn ____ r`] a fattal
be done reakisrtlhl �� 13 15.00
rton•rsaklentlal —
E%"tae of —_
bu§ trtp or property
PR>ppMd use of — _ W&TOTAL
bUQft orpmp" _ NAId1AA0! 2
Tft Pa ra l Dal NA and roto M work a s `p "NOME1.1�n f r 11 few
oon4&U0 m awnor+xed is not corn.
tatart0ed wtrttrt 1(!0 days w r oenalr.ariort or walk im euepandrd or abandoned for
a P"W d 180 fees M any tire•after wart M oatttw•.lmed
MyC�AL OOIbt>rlpltfl
-- -- Deis iaat,+M by
City of Tigard PLUMBING PERMIT Planck/Rez- #
13125 SW Hall Blvd. APF- '-ICATION Permit # -
Tigard, OR 97223
(503) 639-4171
escription
ORS 814-21-610 CITY PRICE AMT
Job i' ���� ' l� {J ( F;XTURES
Addreis ,n
Lavatory
Tub or u ower oma'--- _
Shower Only 7 5
Water ,ose
Ownef Dishwasher 7 50
a ageisposa7 — I
Washing Machine 7
P"f. at—) rain 750 `
Water Heater ( I
Occupant
° ^' aunory oom—tray `
Unnal 750
--
Other Fixtures (Specify)
750
Contractor
MISCELIANFOUS
� ,.,, — -T
ewer 7st
•• •' "." r.. ewer - ea d 100
Water Service 1st 100' 2000
TTere y o now a ge that I have read this app ica ron. jdt IFie Water Se vice ea Addit 200' 1500
information given is correct, that I am the owner or authorized agent of
the owner, that plans submitted are in compliance with State laws, that Storm & Rain Drain 1st 100' 3000
I am registered with the Construction Contractor's Board, that the Storm 8 Rain Drain Addit 100' 1500
number given is correct (If exempt from State registration. please
give reason helow) Mobile Home Space 2500
Bacit Flow Prevention
Device or Anti-Pollution Device 750
Any ,rap or Waste Not
Connected to a Fixture 750
Describe work new addition a era n repair Catch asin
to be done residential Q non-residential O
Insp of Exist Plumbing per hr
F_ 4000
Specialty Requested Inspections per hr
[Xisting use of Rain Dr3in, iingle family
building or property _ dwelling 1500
Reskfential backflow prevension --
devices 1500
Proposed ur . of — --
building or property _
_T(Except residential ow
Prevention devices)
NOTICE 'Minimum Fee (25.00 SUBTOTAL
PERMI rS BECOME VOID IF WORK OR CONSTRUCT19N 5% SURCHARGE
AUTHORIZED IS NOT COMMENCED WTHIN 1FO D OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 190 DAYS AT ANY TIME AFTER WORK IS PLAN REVIEW 25%OF SUBTOTAL s
COMMENCED '
TOTAL.
Srorlal Conditions
Date issued py
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• �.'ITY OF TIGARD MECHANICAL
PERMIT
PERMIT #. . . . . . . . MEC94-0156
COMMUNITY DEVELOPMENT U--PA��NT DATE ISSUED: 06/27/94
13125 SW Hall Blvd.Tigard,Oregon 97223-8147 ( 03) 9-4 71
PARCEL: 1S126OC-01107
SITE ADDRESS. . . : 09648 SW WASHINGTON SQUARE RD #G- 15
SUBDIVISION. . . . : ZONING: C--G
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . .
-----------------------------------------------------------------------------------
CLASS OF WORK. . :ALT FLOOR FURN. . . . : EVAP COOLERS:
TYPE OF USE. . . . :COM UNIT HEATERS. . : VENT FANS. . . : 1
OCCUPANCY GRP. . :P2 VENTS W/O APDL: VENT SYSTEMS:
STORIES. . . . . . . . : 1 BOILERS/COMPRESSORS HOODS. . . . . . . :
FUEL TYPES------------- 0-3 HP. . . . : DOMES. INCIN:
-15 HP. . . . . COMML. INCIN:
MAX INPUT: BTU 15-30 HP. . . . : REPAIR UNITS: 1
FIRE DAMPERS% . : 30-50 HF'. . . . : WOODSTOVES. . :
GAS PRESSURE. . . : 50+ HP. . . . : CLO DRYERS. . :
NO. OF UNITS----------•- AIR HANDLING UNITS OTHER UN I TS. s 1
FURN ( 100K BTU: (- 10000 cfm : GAS OUTLETS. :
FURN ) =100K BTU: > 10000 cfm :
Remarks : Friedlander~ Jewelers- tenant modification
Owners --------------------------------------------------- FEES --------------
WINMAR-CASCADE INC type amount by date r•ecpt.
700 5TH AVE #2600 PRMT f 25. 00 SW 06/27/94 -
PL.CK 11 6. 25 SW 06/27/94 -
SEATTLE WA 98104-5026 5PCT f 1. 25 SW 06/27/94 -
Phone M:
Canty-actor: -------------------------------
ARROW MECHANICAL CONTRACTORS
103: 0 SW TUALAT I N RD.
TUALATIN OR 97062 -------------------------------------
T-'hone #: 692-1565 f 32. 50 TOTAL
Reg #. . : 05193
----- -- REQUIRED INSPECTIONS
This permit is issued sub)ecc to the regulations contained in the Duct Inspection _
Tigard Municipal Code, State of Ort. Specialty Codes and all other Misc. Inspection
applicable laws, All work will be done in accordance with Final Inspection
approved plans. This permit will expire if work is not started
within 188 days of issuance, or if work is suspended for more
than 180 days.
qL
Permittee Signat"lr'e :
/ - -- - —_
Issued By :
Call for inspection - 639-4175
1
City of Tigard MECHANICAL PERMIT Planck/Rec. # �
13125 sw Hall Blvd. APPLICATION �,� Permit # WC `1 1-015
Tigard, OR 97223
(503) 639-4171
r �^• scripuon L
����� �• saQAfM Mf? Tab'e 3A Mechanical Code OTY PRICE AMT
Job - WnsNAoU,, j .�CUrr 1) Permit Fee 0 0- 10.00
Address ap
2) Supplemental Permit 300
umace to 100.000 BTU
1) incl duds 8 vents 6,00
Furnace 100,000 BTU +
Owner 06 PSTO R`14 2) incl. ducts S vents 7.50
f— ZIP i orumance
SenI j L E Id193) incl vent 6.00
--- w—�+ spec heater,wall heater
+ ( J)L%S Sal+✓rL!�i2 `� 4) or floor mounted heater 6.00
Occi:nant —venr tri to
5qv_ 5) appliance permit 3.00
epair oTheat+ng, re ng
6) cooling,absorption unit 6.00
lloilw or comp,heat pump,au co
7) to 3 HP absorp unit to 100K BTU 6.00
Boiler or comp,heat pump,as
D 3 j��c,� G 4 II} 3-15 HP absorp unit to 500K BTU 11.00
Contractor
i er or comp, a pump,air co
U/� /7 ('�� � �G' •1 9) 1530 HP absorp unit 5 1 mil BTU 15.00
Boiler or comp,Foat pump,au cond.
Mr= Ty1il ,2 4 7 10) 30 50 HP absorp unit 1 1.75 mil BTU 22.50
hereby ac ow e that I have rea -is�apphca ton,lhiWe boiler or camp, at pump,air coir
information given is correct,that I am the owner or authorized agent 11) >50 HP absorp unit 1 75 mil B FU 37.50
of the owner, that plans submitted are in compliance with State Air handling unit to
laws,that I am registered with the Construction Contractor's Board, 12) W,000 CFM 4.50
that the number given is corect- (It exempt from State registration, Air hanElling unit
please give reason below.) 13) 10,000 CTM 4 7.50
--- -- -- on por --
14) evaporate cooler 4.50
--- �— Vent far,conno- U
15) to a single dud 3.00
Ventilation system no
ti -1 16) included in appliance permit 4.50
— Hood serverr y -
17) mechanical exhaust 4.50
Descnn5e work new addition a tore n —repwFrr) mercTor industrial
to be done residential O non residential!LA18) type incirwabr 30.00
E7xisting use o "- (Mar t e,woodslow,wallar
building or property �cv J/I r L JA LES 19) heater,solar,doffs dryer,o1c. 4.50 �
Proposed us9 ofr % /L 20) Get piping one to bur ouWfs 2.00
buikling or property :j/�
Type of fuel - of Q natural gas Q LPG O Nsctric Q 21) More than 4-per outlet -
6.4 eS f DL,c rc�)-n.
NOTICE
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Minimum Fee=25.00 SUBTOTAL
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR 5,6 SURCHARGE
IF CONSTRUCTION OR WORK IS SUSPENDED OR — L
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 2S%OF SUBTOTAL
AFTER WORK IS COMMENCED -
TOTAL
Special Conditions �-
Date issued by
vtl(CMM
.�tl4awl.
City of Tigard MECHANICAL PERMIT Planck/Rec. #
13125 SW Hall Blvd. APPLICATION Permit # _ z2k
Tigard, OR 97223
(E03) 639-4171 I�
- I
Ascription
•_•�, Table 3A Mechanical Code QTY PRICE AMT
Job t �' %�, 11 Oermrt Fee -0- -0- 1000 l
Address
2) Supplemental Permit 300 1
1) incl ducts 8 vents 600
Furnace 1100,000 BTU
Owner 2) incl duds &vents 750
«• �r Fumance
3) incl vent 6 00
• ^•^• Suspended eater, wall heater
4) or floor mounted heater 600
Occupant M• "" en not iris rn —
5) appliance permit 300
�•�•• - - e—li parr o heating, refrig
6) cooking. absorption unit ,,f
600 a�
r —
Boiler or comp, heat pump, air cond.
7) to 3 HP, absorp unit to 100K BTU 600
•� ••• Boiieer or comp, heat pump, air con
8) 3-15 HP. absorp unit to .500K BTU 11 00
Contractor „-,.•.•
Boiler or comp, heat pump, air con
9) 15-30 HP, absorp unit 5-1 mil BTU 1500
•• •r •� - •• Boiler -orc-o-m-p--Reat pump, air con
10) 30.50 HP, absorp unit 1-1 75 mil BTU 2250
(reby acknowlAge that I have read this application, that the o r or comp, heat pump, atr con
information given is correct. that I am the owner or authorized 11) > 50 HP, absorp unit 1 75 mil BTU 3750
agent of the owner, that plans submitted are in compliance with Air handling unit to
State taws, that I am registered with the Construction Contractor's 12) 10 000 CFM 450
BvarJ, that the number given n coned (If exempt from State Air an rng un
registration, please give reason below) 13) 10.000 CTM + 7 50
Nen portab --
14) evaporate cooler 450 -
Vent an connected
15) M a single duct 300
entr a ion system no
16) included in appliance pemrft 450
• Hood served y - -
17) mechanical exhaust 450
Describe work new addition a erahon repair Commercial or industrial
to be done residential O non-residential O 18) type incinerator 3000
xising use o r r e, wOWS ove—watef
building or property _- 19) heater, solar, clothes dryers, etc 450
Proposed use of 20) Gas piping one to four outlets 200
building or property
21) More than 4 per outlet
- Type of fuel -oil O nahnal gas O LPO O elprinc ()
-� Minkmom Fee $25 00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED VNTHIN 180 DAYS,OR 54 'CHARGE
J IF CONSTRUCTION OR WORK IS SUSPENDED OR —
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25%OF SUBTOTAL i
AFTER WORK IS COMMENCED - ---
TOTAL
Special Conditions -- - -------__
Date issued by
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CITY OF TIGARD BUILDING rERMIT
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #. . . . . . . . BUP94 -014'
13125 SW Nall Blvd.Tilled,Or*pon 97223.6199 (503)6'39-4171 D STI~ ISSUED: 06/27/94
PARCEL.: 1 S 1"26 0C--01 107
09640 W WASHINGTON SQUARE RD #0 1C1
'aUE D I V I S I ON. . . . : 7 QN I NG: C—G
11.nrK. . . . .
---------------__________________
REISSUE: FLO(7R nREAG _.__._. EXTERIOR WALL CONCTRUCTIJN.
^_'.ASS OF WORE. %ALT FIRST. . . . : 11,00 ,,f N: S. E: W:
7YPC OT USE. . . :COM SECOND. . . : S f PROTECT OE-'EN ING3? _-.
'YPE Of CONST. s SN THIRD. . . . . 5f N: S. E. W
ricruPANrY GRP. :SP .rn-. _. ---1 1600 s f ROOT= CONST : FIRE RET? :
OCCUPANCY t-OAD. 37 PASEME'NT. s cif AREA SEP. RATEDs
^TOR. : 1 14T. : 12 ft GARAGE. . . : r f ncru SFS'. RATED:
39MT7 : mrzz?: READ SETBnCKa-- __
-LOOR LOAD. . . . : p f 1.-EFT: ft RGl IT: ft f I R SPKL:Y SMOK DCT. . :N
DWELLING UNITS: F'RNT: ft REAR: ft FIR ALRM:Y HNDICP ACC:Y
C!7z lm5: L1nT1i : IMP SURFACE: PRO CURR:N PARKING:
�:aLUC. f . .''-,`?000
'�bm .rkra : Fripml ..^-4pr Je►wplprs— tienaknt modification
FEES
AINMAR—CASCADE INC type amount by date recpt
If*f'' f;Tli AVE 142600 PRMT $ 310. 00 SW 06/17/94 ._
PLCK f c^01. 50 05/27/94 94- :::;�.:�)'M:
"71_C WA 90104 -5026 5PCT S 10. 50 OW 01L/17/14
u Itt act Ol .
RL SENF rnN"T PI irT T r1t,' I NC
00 BOX 1353
I.YNNWF)OD WA --------------------- ------------------
206
—_.__--------- _____ ____________--_206 -774 11:3 t 527. .'10 TOTAL
'ta+g f4. . 5365Q1
-- -—_ - REOU I RrD I NSPECT I ONr ___......._. _.
'lis porsit is issued subject to the regulations contained in the rraminy In.p
Municipa: Code, State of Ore. Specialty Codes and all other 1 n s t.,l at t on Ing p
411 w,74 will be done i" accordance ulth Gyp Boar-d Insp
Iap; :.ed plans. This pereit will expire if work is not staoied Susp Ceilny Insp
within lU days of issuance, or if work is suspended for pore Final nal Inspecl ion
than 1M devil.
l t Q e SJ,91 I a1 t u r a. : ` ✓__ - � .._ _____ �_ —
Cal 1 for- ir15[.7er• • - - Wtcs--4175
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NAME: �i,�ca.�c/trS 7,r e let, REISSUE OF:
ADDRESS: !3 L Ave 51 P -_ /-l. LAST REISSUE:
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PHONE: 3, L' � '�� �3oc,
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NAME: OLJT ' C 8i2 'L')C. CrklSly PLANNING:
ADDRESS: ENGINEERING:
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PHONE: OTHCR: _
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NAME: /�A�/- �46<< yr ` / C- ><� r,S f� �5 TRUSS UETAILS: `.
ADDRESS: •/ 32 7 45,f 4ve 5k N
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PHONE: 10 - 375r- G yoo
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— Date Received: 7
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