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C11YOF T'��RD �11iirQD I'r--': PPLAMI'T' NO :11:801.96SCOMMUNITY DEVELOPMENT DEPARTMENT MOON
13125 S.W.Mrll Blvd.,P.O.Box 23397,Tigard.Oregon 97223,(503)639.4175 GA'T'E:: 0/ I .i/HO
I-API.M . VIKr NO EuJ wi
Jnkii A0DA1-*--Sv43 : 11.9,60 SM 122ND CT'
UAX MAP/11-0'r 1513'elc'C3000 5U13. YE'. 01 1.) WINDMIA T : V;I.,
LAND USE. :
i...ol !:i:rzE: :
MAI< A-L'TEMAIJON
LIS-EK TYPE : SIWAJE FAMIA.-Y
(.1,118M YARDS . 1.00 VALUE. :
imr.ni".riv . ARk.:A :
FA:LL.'? : YE15
ENG UNEr:;*:A1-:*D F: 11 L? NO
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IN But'4mi; Bnntlia VIE WHY T 141.115 00
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E 1.1.960 tow 12en(l cr, PLAN REV11EW
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r,HONEF (503) 891 :1'760 S'rAJ In" VAX
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— T1,111AL: 11111115 . 75
This permit Is issued subject to the regulations contained in Title 14 NO. /()/0 9L�
of the TMC, State of Oregon Specialty Codes,toning regulations _..__„._....__.......,_......W.._._.
and all other applicable codes And ordinances, and it is hereby PEQUIPLU INSFIEUT TONG
Agreed that the work will be done in accordance with the plans and
specifications and in compliance with all applicable codes and F”:I:N(A-
ordinances The issuance of this permit does not waive restrictive
covenants Contractor and sub,—ritraclors shall have current city
business tax permits This permit will expire and become null and
void if work Is riot started within 180 days,or it work is suspended or
abandoned for A period of 180 days any time after work has
commenced 11 shall be the responSihility of the permittee to R99LIrP
all required inspections are requested and approved
Perm(tee Signature
C
Issued By 2
Tl ON 6'.Vo /11,
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
�
�rer �r �rw :
s
BUILDING PERMrrAPPLICATION TIGARD DATE_!luly 16 19 '34 49553
TILE UNDERSIGNED HEREBY APPLIES FOR A PERrvIfI FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPA:4YING PLANS AND SPECIFICATIONS. OWNER PHONE_h1Ln2Q2b__
LOT NO..__—._10
OWNER Bonnie Bates JOB ADDRESS 11960 Std 122nd Cr. Ye Old Windmill
ARCHITECT
ENGINEER
BUILDER _ � ADDRESS DESIGNER
STRUCTURE ❑ NEW ❑ Fl�MODEL ❑ ADDITION ❑ REPAIR C PENEWAL O FIRE DAMAGE O DEMOLITION
❑"RESIDENCE ❑ COMM ❑ EDUCATIONAL O GOVT ❑ RELIGIOUS ❑ PATIO M CARPORT ❑ GARAGE ❑ OTORAGE ❑ SLAB[] FENCE
OCCUPANrY LAND USE ZONE K_—_ ALDG.TYPE --FIRE ZONE—,PLAN CHECK BY _ HEAT
Deposit approx. 200 cubic yards of fill on property.
Owner to keep streets clear of dirt and dust.
SEWER PERMIT#
OCC.LOAD FLOOR LOAD HEIGHT NO.STORIES AREA NO.BEDROOMS VALUE
BUILDING DEPARTMENT SET BAGKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit �S.UII THIS PERMIT IS ISSUED SUBJECT 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 _ _ WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH AIA APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES N01 WAIVE
Subtotal 15000 RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
State Tax •11.1
-- -- SDC-
Total 15.60
PDC# AAPPLICANT OOR AGENT
By CH _
Receipt No.
Approved BCH A551RE88 PHON F
DATE INSP. TYPE INSPECTION REMARKS PLUMBING
DATE
Contractor
Permit No.
Flu-igh-in
fixture
Final
HEATING
Contractor
Permit No.
Gas or Oil
ugh..n
SEWER
Final
DRIVEWAY
Final
Storm Drainage
(Rain Drain)Final
Sidewalk
iCurb&Street Final
Approach
iii7tx., DEPT.F-'INP T rEMPORARYC' !FICATE OCCLJPi1,107
CK11TIVICATE OCCUPANCY� Final
landscaping
� y9s3
BUILDING PERMIT APPLICATION TIGARD DATE - "1 191
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHON&'' S;-?-90- --
-ti Al",' LOT NO. /6
OWNER-
ARCHITECT
ENGINEER
l DESIGNER
BUILDER �{�/�? ADDRESS
STRUCTURE ❑ NEW ❑ REMODEL ❑ ADDITION 0 REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEfAOLIfIOn
1jfESIDFNCE O COMM ❑ EDUCATIONAL ❑ GOV`T ❑ RELIGIOUS ❑ PATIO 0 CARPORT ❑ GARAGE G STORA.'E ❑ SLA130 FENS E
OGGUPANCY LAND USE ZONE c .BLDG.TYPE PUN CHECK BY HEAT _
l'D
SEWER PERMIT It
OCC.LOAD FLOOR LOAD HEIGHT NO.STORIES AREA NO.BEDROOMS VP.LUE
BUILDING DEPARTIVENT SETBACKS FRONT REAR LEFT SICE RIGHT SIDE �—
Prrmlt THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE,ZON'.N:
REGUL.A'CION.S AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT T>!i
Plan Check "—� WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COIAPLIANC!
_ WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIV!
Su�tolal RESTRICTIVE COVENANTS.CONTRACTOR AND SUB CONTRACTORS TO HAVE CURP.FNT CITY BUSINES.
LICENSE SEPARATE PERMITS REOUIRED FOR SEWER,PLUMBING AND HEATING.
Stata Tan
Total ---- --------------
PDr-N APPUCANT OR AGENT
By _
�> Receipt No.
Approved ADDRESS Ftx?NF
'./� _.- -_
SSI)(; --- $
SUC --
PUC
SEWER CONNECTION S
SEWER INSPECTION $
SEWER SURCHARGE S
comments:
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CITY OF TIGA PWI
WASHINGTON COUNTY,OREGON
May 16, 1984
hs. Bonnie Bates
11960 SW 122nd Ct.
Tigard, Oregon 97223
Dear Ms. Bates:
On December 7, 1983, you were notified (Please see attached letter) of
several corrections that require completion and approval by this department.
As no final approval has been given, this building is occupied illegally.
If no action is taken to correct this violation within ten ( 10) days
this department will tale legal action against all responsible parties.
Sincetely,
Brad Roast
Building Inspector
1 ..
BR:ch
CC: Duane Potts
2 14 12 Keyte Lane
Bend, OR 97701
Karl Crews
2135 NE 8th
Bend, OR 97701
12755 S.W.ASH P.O. BOX 23397 TIGARD,OREGON 97223 PH 639.4171
1
r O SENDEA: Complete ttens 1, 2, 3, and 4
j Add your addrInss In V ro "RETURN TO"
--__ space on reverse. _
(CONSULT POaTMASTER FOR FEES) .. P 714 137 712
1 Tht follirring service Is requested(Ofck one).
�'f;hm4 to whom ArA date&fNr:ed . ... - —_.a ` RECEIPT FOR CERTIFIED MAIL
shmi to whom.Rate,and address of ReOverr —____I NO INSURANCE COVERAGE PROVIDED
2. ❑ RESIRICTED0111VERY......... ..... a NOT FOR INTERNATIONAL MAIL
trM rgHWdkdW"Men dWW m -
a -
b IM nhra rK40 b.) (See Reverse)
TOTAL �- P. Sant to
3 �tITlCltj ADDF{iSSEO TO - - -- n ��n —
� • '�-' Strey�an No.
1{ 1 11 P.��tete a ZIP Cod,,
u. �.__—Lrj C. (__._ r- C r r
1. TYPE Of:i RVICE: ARTICLE NUMBER I d Postage _
❑ItIGMTRED ❑INSURED
RRTIfIED ❑COD t ')1�
CE -
* Certified Fee
❑EXPREt'9MAll _ _ _
�(Aha)nI etrWnilpnetun M e0dfefap Of sprit) Special Dollvery Fee
I have Ierwtved the arlkM deacd aEcvo.
EIDN ❑ 1/46'hod I agent Restricted Delivery Fee
Return Receipt Showing
! s to whom and Date Delivered_
DA OF ER Iwi ; .
,. A.reva-u I Return receipt showing to wfgm,
0 y v Date.and Address of Delivery
P 0.
ADDRESS EE'6 Add00 fdrMr 1� TOTAL Postage and Fees t ,
Postmark or Date i
.,
= r"
1, UNABLE TO DELIVER BECAUSE: h E 'FES
m TIALS E
n L t
n np*.1taaAB1}643 o \\
W W
v
y e 8ENOF.R: Compete Retna 1, 2,3, and 4.
Add your address In tete "Rh'uRN TO"
- space on revere. P 7114 13? 713
(CONSULT POIRTMASTER FOR FT'L•>E)
I. 1��M"�IMMnp aenlrs h reQrwhsd(chwk oue►. ✓ 6PT FOR CERTIFIED MAIL
yyQQ S,Show towftmand dale dettverad.. ..,.. ...
.. NO INSURANCE COVERAGE PROVIDED
�i ❑Sttowmwtrofn,dse,and�ddnssmdsitvary I WIT FOR INTERNATIONAL MAIL
2. U RESTRICTED DELIVERY..._..... ...........;. .. ----_` (See Reverse)
(The rpW&d AMry oNnw
f rysd In JCil
b ft nacos mow M.)
Sent t
TOTAL
& TICLE fES) T • _ Street afnd No.
�//� /G ,a-ri a P.4111State Pd ZIP o 1O
4. TYPE OF SERVICE- �..L ARTICLE NUMBER c7 Postage S
fA
❑REOISTEREn UINSUREO
CERTIFIED ❑C00 �7�`/�37��� ♦ Certified Fee
C7WWSS_MAIL _ _ Special Delivery Fee
(Ahtfarr oblAINNptlNvn of addrnrea a apart)
1 flava faWW IM aft M described above __� Restricted Delivery Fee
feua ❑AuthoricrM y)ant Return Receipt Showing
to whom and Date Delivered
� `-- � Return receipt showingto whom, ---
OA1pQf/ 1.1VERY i�— !O!{TWAX �"i Date,and Addrusq.o 04llvery
frq M M vert ted"
,d TOTAL Post ee4'..1
6. ADDRESSEE'S AIDES3(dnrr n ArNwMa.� nslmark
a-r
11w i�
A 7, uhAOLE TO OEl IVER BECAUSE: ?1, FM1PLOY S s fi
n OIK}tee?J10AQJ
i
T-^ ,w+srame�.�as�nre
;, • SENDER: CornUlet^Items 1, 2, 3,arfd 4.
Add your address in the "R[TUAN TverA- _gkd t P 714 137 711
space oo rese:.-- ----- -- — �/�
(CONSULT POSTMASTER FOR FEES)
RECEIPT FOR CERTIFIED MAIL
I. The following service Is requested 1040 one).
Show to*torn and dire deilversA .... . .-... __.__A NO INSURANCE COVERAGE PROVIDEU
9�
Show to wfWm,bele,and address of Aerhrery.. �.—t NOT FOR INTEaNATIONAL MAIL
2 ❑ RESTRICTEODELIVEI'V... . ....... (See Reverse'
(Int i funk a am rr r..d dwwe M srWe«r —
I1 ft Mm"mew*I f , P Se Ho
N
T4TAl S— {
1 Streo a d No.
S. ADDRESSED TO r y
ill .ICIE ; rf Aa
.�.-w O P.O t4te an ZIP Code
1F� � r 0 Posta t
1. TYAF SERVICE: :L ARTICLE NUMBER
❑REGISTERED ❑INSURED f 3 a Certified Fee
®CEATIFlED
11 COD
❑MIRESS MAIL Special Delivery Fee
—(AWM o ttin tlprptunt d tdfMttN u tgtRij —
ResPictucl Cie.— Fee
i nive retelvea nleirticN ae_�It»a�oovs. __
SIGNATIME ❑Addresses ❑AutltodzeA Return Receipt Showing
to whom and Date Delivered
r�ll?DL r /X n Return receipt showing to whom,
5' DATF. DELIVERY G1`P08t#AARK Dale,and Addrass of Delivery
Ee nvt.m
Mal ri TOTAL Postage and F'es B� S
f� r
9 ADDRESSEE'S ADDRESS X"N rvwft al Poetmark of FlAt4 i
c.
7. UNABLE TO DELIVER BECAUSE: 7t EMPIjD $'6 LLiALp.
nVl
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i
December 7, 1983 C'TYCWT11FAM
WASHINGTON COU,fY,OREGON
Ms. Bonnie Bates
13.960 SW 122nd Ct.
Tigard, Oregon 97223
RE: Final approval permit #4549 (11960 SW 122nd Ct.)
Dear Ms. Bates:
On November 2, 1983,. a "final" inspection was conducted at the above
refer.renced address.
Several corrections were noted at that time, requiring completion and
reinspection before a final occupancy approval can be issued.
A temporary occupancy approval was granted at that time subject to completion
of the corrections noted.
ha of this date no reinsroection has been requested.
It will be necessary to correct the following:
1. Provide 1" mi,ainum clearance to combustible material. from Water Heater
vent (at roof line). f
Install undr:rt'oor insulation. 1
3. Provide sign for furnace informing owner(s) about closeable foundation
vents.
4. Finish grading around building (right side adjacent to garage) so
slope o bank next to property line does not exceed 1:2, or provide
retaining wall.
If you have any questions please call 639-4171,
Sincerely,
Brad Roast
Building Inspector
BR:ch
cc: Duane Potts
21412 Keyte
Bend, Oregon 97701
12755 S W. ASH P O. BOX 23397 TIGARD,OREGON 97223 PH:639 4171 — –------�
INSPECTION _NOTICE
li City of Tigard Building Department
[ 12120 S.W. Main St.
Tigard,Oregon 97223 1
Phone: 639-4A711
I j ;
Type of Inspection — lij --- ---�
r '
lI Date Requested _ Ti A.M. X P.M.
I Address _ � —� G� –/2`Z� Permit
Owner-__ __— -- ----
Lot #
Builder
The following Building Code deficiencies are required to be cor•ected:
r _
Gs �4-fl �r40Y'1 _I
VF �
�e
i
Presented to n Approved
---- � '
Inspector '"'.� � Disapproved
Date --
CALL FOR REINSPECTION
, YES 0 NO r
i
I
INSPECTION NOTICE
City of Tigard Building Department
12420 S.W. Main St.
Tigard,Oregon 97223
Phone: 639-4171
Type of Inspection -----
Date Requested_ ` `? Time _ A.M.__,P.M.
Address O/�G O ,S �'-� �' �t- Permit #
Owner Lot #_
SUP JerThe following Building Code deficiencies are required to be corrected:
II
I
Presented to Approved
Inspector . — Disapproved `
Date
CALL FOR REINSPECTION
[) YES ( NO
INSPECTION NOTICE
I City of Tigard Building Department
12420 S.W. Main St.
Tigard,Oregon 97223
Phone 339.4171
i
Type of Inspection —
Date Requested 17 Time— A.M.—P.M.
Address _L 7�� ��J ��'° �- Permit
Owner „, Lot #
I /
Builder
The following Building Code deficiencies are required to be corrected:
I
— - 1
Presented to —___ - - Approved
Inspector __ ,[,. -- --.. �_� Disapproved
Date /7-
CALL FOR REIN 'ECTION
C] YES I NO
,BUIUDIN(3 PE!IMIT APPLICATION TIGARD DATE-- 4549
THE UNDERSIGNED HC-REBY APPLIES FOR A PERMIT FUR I HE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
LOT NO.
OWNER JOB ADDRESS
lend ARCHITECT
ENGINEER
BUILDER r,c ADDRESS 214112 * cute DESIGNER
STRUCTURE 13 NEW D REMODEL 0 ADDITION 0 REPAIR El RENEWAL 0 FIRE DAMAGE El DEMOLITION
0 RESIDENCE [3 COMM [I EDUCATIONAL 11 GOV'T E RELIGIOUS 0 PATIO 0 CARPORT [] GARAGE El STORAGE D SLABEJ FENCE
=--_
OCCUPANCY -LAND USE ZONE BLDG.TYPE FIRE ZONE PLAN CHECK BY HEAT—
Conutract .imie ramily uwtiiinf-, tqattAche'&
SEWER iJERMIT#
OCC.LOAD FLOOR LOAD HEIGHT I:N NO.STORIES AREA NO.BEDROOMS VALUE
BUILDING DEPARTMENT SETBACKS FRONT REAR LEFT SIDE RIGHT SIDE
Pe,mlll
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Pon Check 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
Sub-tntal i . RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
State Tax
..-j
Total SDC— $400*0,';
PDC# 100,00 APPLICANT OR AGENT
AGbiT
By
Receipt No.
Approved AnDRESS PHONE
DATE INSP. TYPE INSPECTION REMARKS I PLUMBING D4a.TE r
-- --- -- ---- p
•1�_ ' - Contractor
c D S I 1 ---- - - Permit No.
Rough-in - --
� Future
Final
HEATING- ------------ -
EATING
C/C •
- --�_ ---J Coni ctor
Permit No. -2 O'c?& 1v
Gas or Oil 1--��-- /Ca•F �/t 2
Rough-in —
'-� Final
-ell SEWER
_4-_-A -- I Final
DRIVEWAY -
vA Final --
�- ---_ -- -,- Storm Drainage —
IRain Drain)Final
-•-- ---- -------- ---- Sidewalk
�- Curb&Strcet Final
I A) roach
_ _
C -BLDG. VEPY.FINi.L � TEtd�•ORARY � CER_TIFICATE OCCUP NCY rpral I
C V� irrtRTIFICATE OCCUPANt Y
(Ion;nq Fines'
1•
� ysy'9
BUILDING PERMIT APPLICATION TIGARD DATE
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THEV`ORK HEREIN INDICATED BUILDER PHONE-181 '06s/
OR AS SHOWN AND APPROVED SN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
LOT NO. �[
_O'NNEFi}tOA►Alli e'ATE,i JOB ADDRESS//9b� �, /2 '�® !"�T. �4 r Os,A
ARCHITECT
ENGINEER
9u1l DER�,.�wti C �o-1"T C ADDRESS 1 q/ 2 it-CZ 1/ r c DESIGNER
STRUCTURE &NEW ❑ REMOOEL ❑ AODITION ❑,REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEttOLETIOt,
C;1 RESIDENCE O COMM ❑ EDUCATIONAL ❑ GOV-T ❑ RELIGIOUS ❑ PATIO ❑ CAR RT ❑ GARAGE ❑ STORAGE 0 SLA 50 FENCE
OCCUPANCY _LAND USE ZONE BLOG.TYPE FIRE ZONE:..PLAN CHECK BY HEAT
.mss 1dL,s T'.P v e rins .r f=A�i�y� rQ �� ini v �1� / A r r d G.V ETi?
SEWER PERMIT M o
(X.C.LOAD FLOOR LOAD V 0 HEIGHT / , N0.STORIES AREA/�2 6 NO.BEDROOMS VAIUr'.� osv
BUILDING DEPARTMENT
SETBACKS FRONT Z.0 REAR LEFT SIDE RIGHT SIDE _S r
Pormlt iZ _ THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING COOS,ZONING
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES.AND IT IS HERESY AGREED THAT TPI
Plan cheek 209 '3 WORK WILL BE DONE IN ACCORDANCF.WITH THE PLANS AND SPECIFICATIONS AND IM COMPLIANCI
t WITI ALL APPLICABLE CODES AND ORDINANCES.THE ISSUANCE OF THIS PERMIT DOES NOT WAIVI
I Sub total ,3 RESTRICTIVE COVENANTS.CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINES:
LICENSE SEPARATE PERMITS REOUIREO FOR SEWER.PLUMBING AND HEATING.
state Tax 12 8
SDC—
Total /31
POCO APPLICANT OR AG QT--
ey
Recelpt No.
Approved ADDRESS (HONE
::SDC
POC
SEWER CONNECTION S LY75
SEWER INSPECTION S 3.S
SEWER SURCHARGE S
> •�
Corti:-enta: q--5 — ----
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CITYOFTIGARD PLAN CHECK APPLICATION
CITYOFTI6ARD PLAN CHECK #
COMMUNITY DEVELOPMENT DEPARTMENT OREGON PERMIT #
13125 SW WBMd. P.O.SON=97.ngod.Oregon 97223(SM)& 4175 DATE ISSUED
JOB ADDRESS: /; `, _ ,�, � -
7 TAX MAP/LOT
SUB: LOT: LAND USE:
VALUATION: —
OWNER -- _� SPECIAL NOTES
NAME: T'.. �� �,��,. �- r,��- REISSUE OF: _
ADDRESS: LAST REISSUE:
FLOOD PLAIN/
^` SENSITIVE LAND:
PHONE
APPROVALS REQUIRED_
CONTRACTOR PLANNING:
NAME: ENGINEERING:
ADDRESS: FIRE DEPT _
OTHER:
PHONE: ITEMS REQUIRED
LIST/SUBCONTRACTORS: _
ARCH/ENGINEER BUS TAX: _
NAME: CALCULATIONS: _
ADDRESS: _ TRUSS DETAILS: _
— — PARKING PLAN: - —
LANDSCAPE PLAN
PHONE: —_ OTHER:
COMMENTS:
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
J,k7 10--432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees
1.0-431 01 Mechanical Permit Fees _
10-230 01 State Building Tax (5X)
Building T u —
Plumbing
Moch �-
10-433 00 Plans Check Fee �S
Building -
Plumbing _
Mech
30--202. 00 Sewer Connection
30--444 00 Sewer Inspection -
51-448 00 Street Systole Dev Charge (SDC)
2--449 01 Parks I System Dev Charge (POC)
52-449 02 Parks 11 System Dev Charge (PUC)
31-450 00 Storm Drainage Syst Dev Chrg (SSDC)
10--230 09 TRF h
10-230 06 Washington County Fire #1 (95X)
10-22.0 00 Amart/Wedgewood
TOTAL
REG #
APPLICANT SIGNATURE
Received By: _ Date Received:
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