12475 SW 124TH AVENUE-1 17475 ,:;W 124TH AT-'NUE
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CITY OF TIGARD Plumbing Permit 1 4
Bulding Department No.
Resider,*ia! 0 commercial 0
New lnsLt ion 0 Replace Addition H Altere, ;,:)n Date
Licensed
Plumber --A�4 c-1 7k q xaxc� Owner
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Ad c,ess ALI', �0-104lob Address
72 E3 . -,* (�11
Phone Applicant
CITY 9US NESS I.IC RE ED FOR ALL_CONTRACTOR, A -COI ITRACTORS,
ITEM NO/ FEE T NO. FEE TOTAL
FixturesI•aps7.50 Sewe First'4fe 30.00
Disl,washer 7.50 E;,ici i qivl 00 ft. 15,00
G,qrhnnp F)i 3POsal 7.50 161- --c-lovor Fl6mp Z--\ 7.5qVK 1,
50
50
Water Heater 7.50 Wa r:First 0-0
Backflow Preventer 7.5uach 5.00
Storm& ain rain:F'-st100ft, 0.00
Eachkcldit.' 00 tv 1:.00
Mobile me SXe
(A (specify)::: In�. Rain Drain-SIngle Fa cwellg
TP10
PERMI1 FEE Co,nmentg-
Issued By:-1
STATE % Receipt No. j,' Applicant
ITIAL Signature
For Plumbing Inspection Phone 639-4171
mood
PERMIT TO CONNECT
Tigard Sanitary District
'PERMIT 111° 14 6 4 PATE ----- _ -
PERM"T IS GIVEN TO
OF
TO CO'.QNECT A
TO THE SYSTEM OF TIGARD SANITART DISTRICT
AT
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THIS PERMIT MUST BE POSTED ON TaE DESCRIBED PRFMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMI'► FEE PAIL. ;.. . . . ........................TIGARD SANITARY DISTRICT
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44,
CONNECTION INSPECTED ARID APPROVED
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Address lit/�S - •� Permit No.Permit charge
Owner Connection fee
Paid by
Type of building �«� Date connected
Service rate )ection fee •,:1 S f
Contractor _ tald by Date
Size of connection � ( �` Assessment __ Paid