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14295 SW 112TH AVENUE-1 Y 14295 SW 112TH AVENUE KM M ML;AA4AN1CAL FIERM11 CITY OF TIFA RDCrry RD PE---PMJ:*I' N(l. : ME 881925 COMMUNITY DEVELOPMENT DEPARTMENT DATE 1SSUED: 9/28/88 13125 S.W.Hall Blvd.,P.O.Box 23397,Tipwd,Oregon 97223,(503)639-4175 i:)m,r .NO. 881.925 J01' (A 1*)DRIESS : 1.AP91 SW 1.1Z.111-4 AVE (AX ,KAP/LUT SUB : L I' : DK : LAND USE : T T,F:M NO: rata WOPK CLASS : (-)D[):E'1'1:(:)N FOPNAGE <100K AIP FIANDLP <10 USE I*YPIE: S:I:NGI...F--. F'AM.I:L.Y 1.001(+ A1P HANDLP 1.01( U:)NS*T . '1'YPE : VN F1.00P F'UPNA(A-: IEVAP -C',00LEW Occup . GPp. : 113 VE:N*T FAN VEWT VL-*:N'T* . SYS'TE'M 8LP/(.1OMP <31.4p HOOD NO . STOPIES : FILA/(::UMP "13 1.;)1..11:' 7.NC'J:NE".PA1*0F4(DON I NG I NERA'T'OP((,'OM F IJEL *rYPF.. WOOD ul...P/(:IIOMP PEP61P UN111's MAX . 1NPL)'r EA-W/COMP -504-HP I:'*TAI_".. umppsve GAL.) P'LIPTISIL-, 01.171.E'T'S V11CF1 Pl:;lE*:5s7 I Ow 1:44F.KL-i's'? W 1:1 C)(.1 !;1 P.c)V 68 0 I<et 0 W 1d1r.W5 H;w 1.1;.*:?th ai.vrl? I'l i)N l4lE.V:I:E:W N E d tar, 9722el )PES R (503) 6P.0--143041 J 10 11::' TAX C 0 N R A C T(J1 Al.. dl 1. .23 ISID, This Permit is Issued subject to the regulations contained in Title 14 ------- ......................... of the TMC. State of Oregon Specialty Codes, zoning regulations 4 1'.:(A L J 1:14 IE 1) .1.N S V"L I TO N 5 and all other applicable codes and ordinances, and It is hereby F: T.N AI... agreed that the work will be done in accordance with the plans and 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 business tax permits I his permit will expire and become null and void it work Is not started withir 180 days.or if work is suspended or abandoned for a period of 180 days any time -Iter work has commenced It shall be the responsibility of the permittee to assure all required/inspections are ieques'-d and approved I eiPrmitt Signature Issued By11 I 1:ON 1.NSPI I I TON 4639-4175 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE 1 k i I 001 Cis «� tc otod a u \1 m , w u � H O � o Ito to a }' d "D ° ! O O H —4 0 ,) b4 " CT 9 V �+ N .6PIN to ,+ I (� .a 0 Ln w + 1 �y. !I nraao-awavaioar�creo-aawann•arbrcrzimr - ti D,4 +� �^s•;--a-•-��.��„u� ,. ,�--ter--���--�u��` ,.,����f� �'.r•,�1h .yM. IN /� t v 1� • ,�� �t ;�i.,.4� ��• '"' �s,� 11� •� .s..,�� 1y�,:a•4M:• j: ��.:,pn�9!.s. ',ti, �++� INSPECTION Nc hCE City of Tigard Budding Department P.O. Box 23397 Tigard. Oregon 97223 Phone: 639-41 if, /� Type of Inspection _ / {�y 1 r Date Requested la - C Time A.M. P.M. Address 1L t> Permit # � Owner Lot # Builder V, 2 The following Building Code deficiencies are required to be corrected: Presented to Approved Inspector ��i ' �- -- � Disapproved Date CALL FOR REINSPEC770N C7 YES U NO INSIPF.ICTiON NOTICE City of Tigard Building Department P.O. Box 23397 w1111 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection — CA—) Date Requested _.._(z L4 �1 Time A.M. P.M. Address 1�4 2-9 t 2- _ Permit # C9 11 Owner Lot # Builder_ The following Builc'ing Code deficiencies are required to be corrected: Ci-4 f 4/ n/1 ♦ f, oft PresentAtjl� pproved Inspect ❑ Disapproved Date CALL FOR REINSPF; .TION ❑ YES 1:1 NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Coy)Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Al (L'1 `� Date Requested " z-Ci Time A.M. P.M. Address Z,�l CJ Permit Owner_ Lot # Builder KQ-n The following Building Code deficiencies are required to be corrected: ^ow Presented to Approved Inspaator ❑ Disapproved Date CALL. FOR REINSPECTION ❑ YES ❑ NO w w w w INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 ��- Tigard, Oregon 97223 Phone: 839-4175 Type of Inspection �l j `r r�C. q f G.k� Date Requested Time A.M._ / P.M. Address '___ �l _ Permit Owner _ Lot # Builder The following Building Code deficiencies are required to be corrected: g N' (.YY ��..�t�t�(i Y.Y C�TiL�L.L�C'i C�,�'/l�C�u--'1� G L('.��_.,.f�+C� /C,+►'ti-'�--. Presented to ` [� Approved Inspector /�-� �_�}'Llisapproved Date 7 � CALL FOR REINSPECTION [] YES NO APPLICATION — STREET IMPRO`JEMENVEXCAVATION COPY TO ORDINANCE NO. 74.14 O (WI , -FILE YELL-W)-INSP. (INSTRUCTIONS ON SEPARATE SHEET) (PINK)-0' .,ER AGENCY]<.L(!( , ❑ (BLUE)-APPLICANT APPROVED APRLICATION NO.. NOT APPROVED ❑ CI1Y 01' 1IGARU, OREGON FEE AMT. S PENDING FEE PMT. ❑ CI I Y 1-1ALL RECEIPT NO.: -___._ 1__' PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT RY -_ -- DATE I L` PENDING AGENCY ''OK" ❑ Application and ProKTcss Record - - ti - Y - - - - - - - - - - - MAINTENANCE BOND +k PENDING INFORMATION INFORMATION [ FON STREET IMPROVEMENT/EXCAVATION AS RFOUIREU ANNUAL PENDING VARIANCE 0 1 EXPIRATION DATE: f_ PERMIT NO.: r,j..''7 - DATE ISSUED BY - -� (1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND IN'S TAL1- - _ AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS. APPLICANT Y_yIrl� l Asc;'; JJ4+ y.u�, rF',c+irr.y .:77, '7,:,,, oi". .i!:3 _ ADDRESS CITU PHONE CONTRACTOR. Pa(al ."tiler i3o, F'ii."�-65112 NIMM ADDRESS _ ...__ CITYH PLANS BY �2' C1L� / — :>1:7U1d,.`,1'C;,i ;tt i�.+1 :., _-- OAR NAME ADDRESS --- CITY —TMON[ .'STIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ — A_.. DOLLARS CMIN. (2) EXCAVATION DATA: FOR OFFICE USE0.04 X s STREET DESCRIPTION _ PROGRESS & INSPECTION_STATUS NAME.- SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE. BY TYPE LENGTH WICTH DEPTH ITEM 6 QUANTITY ^— STREET —�. --� —.— INPEN .D SPEC- — — R TION _ U ESTIMATED STREET OPENING DATE:---- / / E - - S ESTIMATED STREET CLOSING DATE: — / / T -------- --___ — E D (3) SECURITY NO. SECURITY AMT S STREET GLOSEU SURETY CO.: FINAL �— __ r NTIr1ED CHEc Kr ASR n isONb r INSPEC. (4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS / CONDITIONS FEATURES. EXCAVATION LOCATION AND EXTENT. -- I (S) NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE RIGHT OF-WAY JURISDICTION IS THAT OF WASHINGTON COUNT(' OR THE STATE OF OREGON, THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PI:RTI'_2 NT LAWS AND CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF' THE WORK, AND TO SAVE HARMLESS THE CITY AND EMPLOYEES AGAINST ANY INJURIt OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS, APPLICANTS SIGNATURE ' DATE • LjLjuu Jo P.0.Bac 2W7 CITY OF TIGARD PLUMBING '-a �' f PER M IT Ti� (R TM ^pplicants must hold Orcgon Registration an conduct s plumbing 639-4U75business or must be prop"owner/operator nal hiring outside help. Nante of DwrWp*»M MurrhbtnµPerttni No. � &***es --- - roo,oTM,00n job , Tu Lot Map.No Address ------ FIXTURES Lot 96ock Subdivision - Sink / 7.50 a name-o�uainess - Lavatory Zi 7.50 9 a. Addr�-..rs j0�-- ---v.-- Tub orTutYShowerCo" � 7.50 spa — ' Shower Only — 7.50 Owner City/ to zip/ Water Clow z 7.50 DO 7-.e,4,�a Dishwasher -- -- 7..3) Morse Garbage Dtsposai- ---- _ 7.50 2 - Nome -- Washing Machine _ 7.50 _7 Floor Drain 7.50 _ eels - Phone Water Heater _ `y 7.50 Occu pent -- -- - - Laundry Room Tray -_ 7.50 t;ky/State hp Unnal 7.50 Marne vane Other Fh(twes(Specify) -- 7.50 7.50 Address Contre0or /State ZJP 7.50 j,A.� _ MISCELLANEOUS C:Nv But' Tu No giitsBkip-a-&mCrdTW— ',;tale Plumbers Bus Lie.No Sewer ea.Addle 100 15.00 - (Res4enbal) %3-51Water Service tat 100' 20.00 ,0 I hereby acknowssrfge that I have read this appacatlon,that tw Inknmabon Water Sewba ea AddMO' 15.00 Vven is aor*ect,dal I am registered with t»State Builders Boani,and also Stone b Rain Drain 1si.100' 90.00 hew a State PkaytAr g Wahse the the rxxrthwj given are cone,that sn pkxnbrrp work will be done in accordance with appicabis provisions of Orr. Storm i P yn Drano Adds.100' 15.00 -- gm Revised Stakit"Chhapion 4A7 and 693 and wxAKWA andel and that Mobile Horne Space 2500 no help we be ernpkyyrsd uMess kwnaed under ORS 693 lM ecemtt t"wri - State registration.pleats gree masm below) Back Flow Prnevw tv.,n HOMEOWNERS - I hereby caftit) and I am ter owner of Ihhe property de- Device orAno-PokAronDeme 7.50 scrbW at►ove,al wt*h location I propows to m41,4 a pkrnbing instakatan for Any Trap or Waw tool eery own use and this property In not bekng oorrstrwied for sale,tease of red Canhecaed to a Furs" 7.50 Caeah twain A�- 7.50 hsao.of Exist PtanOra0 00 PM HrPaWasted 40 00 Per Hr Alwr of Pkm-it*p wIM an Euwehhg 9teg 16.00 min A F Uw Oft or am Ammw --- 26 M � .00 m 1 1 Describe WQf* �ttton w robon❑ iW,0 ] ► , 15.010 LV be dale melderttiel nmt-reeii6wittal u Exwkv Looe a Evoking or property - - . muwm AL .,,..,ta �,► :. dVia r or property -- Thk P01-1 bet:sena nun rid roto 0 wars cr canAucAm w0wUed Is not aom "14111 eel Mtn 160 dem"f owlwv l w or woo r MwOended Or dhrsdtnvd b •P41rW Of W eey.all ashy ewe tyle wort Is oornwwsoee .r,cxu 00fMol7tnal. ..-_ _ Deg bMMO 1,1 w w er w w w� w BUILDING PERM 17 APPLICATION DATE__— HE UNDERSIGNLD HI-RELAY APPLIFS FOR A PERMI I FOR THE WORK HEREIN INDICATED BUILDER PHONE ,20-4304 LIR A`:SHOO-IN AND APPROVED IN I HE ACCOMPANYING PLAN'-,AND SPECIFICATIONS. OWNER PHONE LOT NO. 1 t OWNER K01y IIE:th SiSca JOB ADDRESS .t112th Ave— stimc 9765 SW 1'.Lowing 'Pig. ARCHITECT_- Barciay fy ENGINEER BUILDER ADDRESS DESIGNER STRUCTURE NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION df RESIDENCE ❑ COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS J PATI(1 ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB FENCE OCCUPANCY r 3_LAND USE ZONE R4--5 BLDG.TYPE 5?1 FIRE ZONE� PLAN CHECK BY _ �T HEAT rt i ngi ln .,'- ) r�•- ,1 to a r. t-n Ax'i [•nglo- In -.1 h '9 C .i --"-=+�:i- �'..1�(' �';��113 '!.ilk' .S+.rr1i'_ •l. __ SEWER PERMIT# 1.1042 ( ldu) ,' briths, 7 9:T•nps (mrFi4ju r rc' .T 460 OCC.LOAD FLOOR LOAD 40 HEIGHT 3,E NO STORIES 1 AREA 1='32NO.BEDROOMS VALUE 7.t00f1 BUILDING DEPARTMENT SETBACKS FRONT W-AR LEFT SIDE 7 RluHTSIDE 1212" Permit _ _ 46_00 THIS PERMIT IS ISSUED SUBJ'CT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES. AND IT IS HEREBY AGREED THAT THE Plan Check 224 .90 WORK WILT BE DONE 114 ACCORDANCE WITH THE PIANS AND SPECIFICATIONS AND IN COMPLIANCE WITH ALL APPLICABLE CODES AND ORDINANCE:, THE ISSUPNCE OF THIS PERMIT DOES NOT WAIVE Subtotal _ RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS LICENSE,SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND BEATING. State Tax _ 1 7 .SO_ Total 5M5.20 By 100.00 PDC# 1 150.00 APPLICANT OR AGENT !--� - _ A / - Receipt No. Approved —_—_---__— - �, ADDRESS _PHONE r• DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE 9- N�lr V u Contractor .ia 18—r7 Permit No. S39 p. � �.ijilll✓�+ T Fixture — J�.v Final J / HEATING �-1^. _ t♦ � 4 V.IA. Contractor j UK 0 t Permit No. r� , �^^�it/� — Gas or Oil r r_ r O� Rouph•in — '/ Final SEWER Final u � IcveC - DRIVEWAY Final Storm Drainage (Rain Drain)Final Sidewalk Curb&Street Final Approach ---- BLDG.DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY Final CERTIFICATE OCCUPANCY - Landscaping Zoning Final CITY OF TIGARD BUILDING DEPARTMENT PLAN CHECK NO. S� PLAN CHECK APPLICATION DATE RECEIVED:_ l P.O. Box 73397, Tigard OR 97223 P/C DEPOSIT PAID: This is to certify that the attached sets of plans have been submitted for plan check pursuant to the Oregon Structural Code and Fire & Life Safety Code, edition. PROPERTY OWNER: S, S C C OWNER'S ADDRESS: CONTRACTOR: TELEPHONE: JOB ADDRESS: �� �? LOT NO. & MAP: DESCRIPTION OF WORK: Approvals Required SPECIAL NOTES OPlanning Dept. O Reissue O Eng4aeering Dept. O Flood Plain/Sensitive Lands O Fire District O Sewer Availability O Other O Other Items Required OList of subcontractors OBusiness Tax `) Calculations OTruss Details OParking Plan 0 Landscape Plan Other COMMENTS: City of Tigard Building Department BY: VLAN OILLN NU. for inspections call 6:19-4175 PERMIT N0. CITY OF TIGARD 639.4171 DATE '•---- � �' BUILDING PERMIT ' "� SUBDOnSION a� P.O. Boa: 23391, Tigard OR 97723owqwmiN TAX M1�P 5�/w��R/OT NO. �� JOB ADORZSS,Kf -u±A ' BUILDER "`'� � �•' LLQ STATE REG.NQ EXP.DATE BUILDER'S PHONE )Z � �L/ �5 PHONE OTHER �� � ARCHITECT r-rI - STRUCTURE Q NEIN O REMODEL ❑ ADDITION ❑ REPAIR ❑ MOVE ❑ OTHER L7 DEMOLITIOt' RESIDENCE ❑ COMM ❑ EDUCATION ❑ IND ❑ REUGIOIM ❑'ACCESSORY [IGARAGE O OTHER C3 FENCE OCCUPANCY tS -5_LANG USE ZONE 1..'�- BLDG.TYPE _FIREZONE PLAN CHECK BY FEAT------ Construct single family dwe11 in^ •'.at' 'chp� narane ali.ppr- appl"acad--P 4, )r to 85 code, — SEWER PEAWT0 '(ldu)� baths_ traP`� �aaraa�_a _ ,y OCC.LOAD FLOOR LOAD HEIGHT NO.STORIES AREA NO.BEDROOMS VALUE, BUILDING DEPARTMENT SETBACKS FRONT Z Z- REAR `)r LEFT SIDE 7 RIGHT SIDE/ 1 3 pKrtdt THIS PERMIT•a ISSUED J THE REGULATIONS CONTAINED IN THE BUILDING CODE,ZONING, REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES„AND IT tZ HEREBY AGREED THAT THE Pun Check WORK WILL BE DONE IN ACCORDANCE WITH RHE PLANS AND SPECIFICP'.:ONS MO IN COMPLIANCE WITH ALL APPLICABLE CODES AND ORDINANCES.T"E ISSUANCE OF THIS PERMI? GOES NOT WAIVE PLCkF" RESTRICflVE COVENANTS.Cf)NTRACTOR AND SUB CONTRACTORS TO HAVE CURNENT CITY BUSINESS TAX PERMITS.SEPARATE PERMITS REGUIRED FOR SEWEIIf•'P-L'U-MIBI,NO ANO"EATING, State Tac U 5500 - p� ---- Told , G• U APK_X:; NT OR AGENT �f Prepd. Rd-0401 No ADDRESS tj -- — Issued BY---_--_A►pprov9d By_ SSDC -- 5 SOC – - RECEIPT # POC – j _� DATE PD. SEWER CONNECTION 5 AMOUNT PIT SEWER INSPECTION S SEWER 5UNCHA11GE S •„//d/'7 A•Ml C. ,ommento: 1 Wp r�Sl'1 Pe� FLAN CHEEK NO. Ior inspections call 639--4175 CITY OF T"IGARD 639.4171 PERMIT NO. DATE w�-- BUILDING PERMIT P.O. Box 23397, Tigard OR 97223 TAXMAP __ LOTNO. _SUBDIVISION JOB ADORESS — BUILDER STATE REG.NO. EXP.DATE BUILOER'S PHONE ARCHITECT __ PHONE OTHER— STRUCTURE m NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR ❑ MOVE _ O OTHER 0 DEMOLITION ❑ RESIDENCE ❑ COMM ❑ EDUCATION ❑ INO ❑ RELIGIOUS. ❑ACCESSORY ❑ GARAGE ID OTHER U FENCE OCCUPANCY _LAND USE ZONE BLDG.TYPE —'J FIRE ZDNE PLAN CHECK BY d c 1_BEAT Construct single family dwei l ing w//+atttached 4aArape/,�,,d�al l {ger approuad pInAc — Str anrt to RS code. 7 TL'��` �(d —JK�Ail tw_��1.i SEWER PERMIT c, -(ldu) baths, traps oara9e area OCC.LOAD FLOOR LOAD HEIGHT NO.STORIES AREA NO.BEDROOMS VALUE G�� BUILDING DEPARTMENT SETBACKS FRONT REAR LEFT SIDE RIGHT•SIOE Permll [ THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING REOULATION.S AND ALL APPLICABLE CODES AND ORDINANCES,AND IT IS HEREBY AGREED THAT THE Ptan Chock 1 WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AMD SPECIFICATIONS AND IN COMPLIANCE WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE PI.CIL Fire _ RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS TAX PERMITS-SEPAP.ATE PERMITS REOUIREO FOR SEINER PLUMBING AND HEATINO, Slate Tar y7 r2 3 _,;rY, Total APPLICANT OR AGENT POG Prepd. Recelpl No ADDRESS Bal.Due , Issued 13y__--Approved By_ SSDC --- g SOC - RECEIPT N Poc -� 4 __ DATE PD. ISCLIER CONNECTION S AMOUNT PD. SCWER INSPECTION S SEWER SURCHARGE S _i ns w w w w w ® w I IUAHU IVILGHANICAL PERMIT - Permit # Description City of Tigard Table 3A Mechanical Code CITY PRICE AMT — ------------ 13125 S.W. Hall Blvd. 1) Permit Fee -0- -0- 10.00 P.O. Box 23397 ---- - — Tigard, OR 97223 2) Supplemental Permit 3.00 639-4175 Furnace to 100,000 BTU 1) incl.ducts&vents 6.00 2) Furnace 100,000 BTU i — incl.ducts R vents 7.50 Name of Development 3) Floor Furnace incl.vent 6.00 Job Add,ess — --- �" 4Suspended heater,wall heater Address ) or floor mounted heater 6.00 Tar Lot Map Nu„ --- - 5) Vent not incl.in .--------�_ - Lot Blockappliance permit 300 ;iutrliwsion _ Name(or name of business) 6) Repair of heating,refr ig., cooling,absorption unit 6.00 Owner Mailing Address Phone e:4 O-y 3 7 Boiler or comp to 3 HP -I-t/ ) absorp.unit to 100,000 BTU 6.00 City/State Zip e) Boiler or comp to 3 HP-15 HP absorp.unit to 500,000 BTU 1 1.00 Name 9) Boiler or comp 15-30 HP absorp,unit 1/2-1 million 15.00 Mailing Address Phone 10) Boiler or comp to 30-50 HP absorp.unit 1 -1.75 million 22.50 Contractor — ---- --- __ City/State Zip 11) Boiler or comp to 50 HP absorp.unit 1,750,000 BTU 31.50 Stale Hegisuation No City Bus.Tax No. 12) Air handling unit to 10,000 CFM 4.50 I hereby acknowledge that I have read this application that the information given is 13) Air handling unit correct,that I am the owner or authorized agent of the owner,that plans submitted are in __ 10,000 CFM + 7.50 compliance with State laws,that I am registered with the State Builders'Roard,that the 14 Non pot table number given is correct.(If exempt from Stale registration please give resaon below). ) evaporate cooler 4.50 --- -- 15) Vent fan connected _—.-----__ to a sin iuct 3.00 16) Ventilation system not -. included In appliance permit 4.50 17) Hood served by _. mechanical exhaust 4.50 Signature(owner or agent► Date Domestic type Describe work [] addition 18) incinerator 7.50 61 alteration n repair F7 --- Existing be done residential S) non-residential 1 I Commercial or industrial -` - Existing use of t 9) type incinerator 3000 building or properly _ 20) Other i.e.,woodstove,water Proposed use of heater,solar,clothes dryers,tate, a `'0 building or property - - -- -- 21) Gas piping one to four outlets 2.00 type of fuel- oil (] natural gas I 1 LPG I I electric F] - 22) More than 4-per outlet NOTICE — —... THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON- SUB-TOTAL STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 190 S&10 06 SURCHARGE DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 190 DAYS AT ANY TIME AFTER PLAN REVIEW 25%OF SUB-TOTAL WORK IS COMMENCED. TOTAL Special Conditions - -4--- --- Date issued_ .__ by