14285 SW 114TH AVENUE FILE NO.
114TH AVE. - 14285 STR. OPN. PERM TT
r..
•`L{K
CITY OF TIGARD--12420 S.W.MAIN—TIGARD,OREGGN 97223
RF'_'EIPT
DATr:. AMOUNT:
=75-
___D0LLAQS
NAME:
CA
_ a-)_
ADDRESS:
____:LCAHECK.
10 OF
FOR: ACCT. # PERMITS SURCHARGE AMOUNT
�cWER BILLINGS 40-364
BUSINESS LICENSE 05-331
PLUMBING PERMIT 05-332
MECHANICAL PERMIT 05-332
BUILDING PERMIT 05-333
SEWER CONNECTION 40-363
SEWER INSPECTION 40-365
SYSTEM DEV CHARGE 25-366
PARK DEV CHARGE #1 30-367
PARK DEV. CHARGE #2 30-368
ZONING ADJUSTMENTS 05-362
05
TOTALS
PECEIVED 9Y:
PERMIT NUMBINI 881614111):
yLi-V
T �Mljnj
Numbw Amount
Number Amount Number Amount
S_
rR'c="pT#====i�4�54
i
APPLICATION — STREET IMPR EMEN1/EXCAVATION COPY TO:
ORDIN-4CE NO. 74-14HITEI-FILE
'r;F,
(INSTRUCTIONS ON S�PAFATE SHEET) ❑ (YELLOW)-OTHER AGENCY
INK)-APPLICANT
API ,OVED APPLICATION NO.. _ f4
NOT APPROVED /❑ CITY OF TIGARD, OREGON FEE AMT.: S v`B'k '�-
PENDING FEE. PMT. ❑ CITY HALL RECEIPT NO.: 2454-
PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT BY 3-Z`E) DATE_ --L_�_
PENDING AGENCY "OK" ❑ Application and Progress Record
- INTENANCE BOND 1t�' I p-
PENDING INFORMATION CI FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED ^r7
ANNUAL p
PENDING VARIANCE ❑ EXPIRATION DATE r'
PERMIT NO. �� –79- CATE ISSUED ��91—�. .__. , BY:
t) APPLICATION IS HEREBY ADE TO EXCAVATE FOR AND INSTALL �►� raw�Fd _I��C
Itxi` AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH I Y REQUIREMENTS.
APPLICANT Vie yV10- M6-'%4v'_---– /#'74S '; �',', jjy1c-- _ __ Tf ___
NAME ADDRESS CITY- PHONE
CONTRACTOR T114f'►t��f _I4�<St S,W,/VBL Tls pfd _ 3�— 391
NAME ADDRESSCITE- ��ONE
PLANS BY_ VFrvter MUs-� 19".%- S 14".
NAME ADDRESSf C TYHP ONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): E 200, "5--
DOLLARS
FUR OFFICE
(2) EXCAVATION DATA: --
0.02 x i
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM 4 QUANTITY
STREET
NE _
INSPE .
<- R TION
O
ESTIMATED STREET OPENING; DATE:_ / / E
S
ESTIMATED STREET CLOSING DATE: / / T
E
STREET
(3) SECURITY NO. __ SEC RIT AMT.: 0 rp CLOSE _
(4) PLOT PLAN: NDICATE Nom` V� FINAL
SURETY CO.:
CERTIFIEDCHECK � CASH ❑ SONO O INSPEC. .� _��•��
SITE PERTINENT PHYSICAL SPECIAL PROVISIVi0S/CONDITIONS! Li7�
FLATURF', EXCAVATION LOCATION AND EXTENT.
I I 1 1 --
I
LuR9 - � � _ � r r � r � J �
ON-
-C� 1k^_ �%A 0k C- �kr C.le r c vv e h r<v\
,R4- I 1 CI S
1 I 1 I
1 I t I
(5) NOTE: THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TOL CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON.
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SFCURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
APPLICANTS SIGNATURE; v p��� ���Q DATE��1 /7 F
i
C r - — -- --
���,,,... ��V mss-
14
ejJ
c : Ali'
rf 1 'V' 1b y c�yb ; 1 t1 4L
t� IU I" tl
rl +ltOtt
►� Ir
i J
t W � t +
` 6'1
t 5 U
All
%j6j
'� ,1'� �.,bbt5 I� •�+ tet'
16
I '
rl
tl, .i
1 ..
_ ..ter•' �
-AI