14890 SW 106TH AVENUE 14890 SW 106TH
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CITY OF 1GARD PWMBING 1� sw lbu
Appacartts "ltlft hOW 1 + Regimmion a condor a Ourn6r, PERMIT. T�
CR 97223
business or"rust be property owner/operator not Nrins ens-ick help. 63D-4175
NarrN of Oevebpnartl
I Pltsrlbrng Permit N0
`too Tait LW --- Map.NO.
Atidreea
FIXTURES
Lob BW* Subdivtabn -- -
L—
Si* 7.50_
Name a name 4 business) Lavatory -- 7.50
— Tub Or TuWShower Comb 7.50
ess ---
Shower OrVy 7 50
Owner / to ---- Zip ^ Water closet _ T 7.50
Dishwasher 7.50
Phone Garbage Usposai - — _ 7.50 -
Name Washing Machine- -- — 7.50 -
.{ Flm Drain 7.50
ess Water Heater --- - - 7.50 --
/
134
Laundry Room Tray — 7.50
C"y/Stall _
Occu ant _
P -- - -- ----
ti Uinal _ 7.50
Other Fnmyos(Specify) 7.50
-
7.50
LuAi—v WR; Phone
7.50
Contractor City/State —_ ZIP
-
_ MISCELLANEOUS
City Sue Tax No count t r Mr
tea --mi-'u 14-6 tat s Lac No Sewe►wa.AdOA too - 15 00
(Readanaal) Water Service t a 100 20.0_0
I N"by adcrxwrfedpe IhM 1 neve read Ihb 1 IMI ft V*xmaiton WaW serviceaa.Addrt.0' 15.00
9iVen is owed,hat 1 am rvostsred with the State Builders Hard,and also Storm A Rain Drain 1 at 100' 3000
hew a State Pkvr ting ken"That the rxr hers given are oa"ect than aA --------
pi rnbing work wig be done in accordance with applicable provisions of Ors- Storm i Pyn Drain Add" 100' 15.00
9011 Revised SUdufes Chaplerl 417 and 093 and appkabie o0des and that Mobile Hww Six - -- --- 2500 --
ro help will be employed unless Acerised under ORS 1193- (11 exempt"m ----
$tato r *myon,please"reason below) Bats.Flow Prevention
NOWOWWRS-I lwebr ow*y that t am itw owner d the property do- De's at Anli-PokibQn D.,&W* _ 750
screed above,at wtyah tocaaon 1 propose a mato a plumbing hViAndw for Any Trap or Waite Nd
my own uw and thio pmprrty Is not hekq eoristmialW kir%W.1""or rent c4mecrad to a Rowse 7.50
Catch Basin V �7 50
trap d Exist P►rnbm9 1 - 40.00 Per FM
&P"h fi Westad inapecitorn 40.00 Per w
�.-- After d Pka." wNMn -
` 15.00 min
ALM40A ZED WMATUM Dau Mare flklp.a llti4d.ArMain 15.00 rrdn
min,Wgie foully _ --
Descrft work new U addition[ ) _-r'lenalton U —r"AlF C7 dell15.00
men"F _..-
Exh"wt+of �yw�
tNAk 1p or proc»nr
"MCI - ---- ---- _ TtTTNIM
Tf4 ptAtntt hwaomiie wA anti ra11 N Iw k er ear oyallan wlrts NW to ria taw
s ogee M ea ��5 a�n ar uoAtb wllAntial a tlbwdW d_
tt1lN M ary ittte twar.alt w aenttatlrtoed
14890 SW 106TH AV,NUE
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ADDRESS /fib`<< a1i �G'Co l/-� PERMIT N0.
PERMIT CHARGE
OWNER CONNECTION FEE
PAID B1f� �c�c '�,,
TYPE OF BUILDING . DATE CONNECTED �� -71
SERVICE RATE 3 -7;cGh--4 INSPECTION FEE
CONTRACTOR PAID BY DATE
SIZE OF CONNECTION ASSESSMENT PAID
owl
PERMIT TO CONNECT till
Tigard Sanitary District -
.�� L•�xXrc''�st,G'�r�l;
PERMIT N° 1513 DATE -
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c:"a,��.,/• red''(�.� ��� r:r� .��;/u��. -
PER311T 1.9 GIVEN TO •e
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMITJ FEE PAID a...`'!'..C... . . .......TIGARD SANITARY DISTRICT.
BY
CONNECTION INSPECTED AND APPRII.VF:D
Date Superintendent