13985 SW FANNO CREEK LANE ADDRESS:
i:\reccrdslmicroflmltai gF�tslbuilding.doc
CERTIFICATE OF
CITY O TIGARD IOC:CUPANL Y r w F t
COMMUNITY DEVELOPMENT DEPARTMENT DATE I:SSUEDt 07/07.ig4
13125 SW Nall Blvd. Tiperd,Oregon 07223.8190 (56,, 639.4171
PARCEL: 2SI020D 01700
SITE ADURE�iE7,, w . a 13985 GW FANNO CI<L=.FX Ufa
13UBD i V i 5I CIN. . . . s FINLEY PARK ZON I NG s R-•7
DLOCK. . . . . . . . . . LOT. . . . . . . w • • • w . toot
CLASS OF WORK. s NEW
TYPES OF um. . . .-sr
OCCUPANCY GRP. a R 3
OCCUPANCY LOAD i Z:44 4
TENANT NPME. . . r
Remarks: PATH I
Owner.,
JOY MILLER
V, 0 BCIX 23291
rIGARD OR 97281.
Phane #s 684•-7543
C:ontratr_tors _...._..W_�..._.__�._____.._
JAY MILLER
PO BOX a3.2191
1 ARD OR 9 72 81
Phone its 684-7543
pl.g 1t. . 9 30 101)
Occupancy of the 1stbove refer-enl_•pr1 building ts. tl _rEt.r; y1 , i, aiisi c :er ifse ;
r he c:orpl iatnce with the St atai. Of Oi-r qon Spt?cialt ; C odei frtr th.e atru ..ip,
o: _uparrcy, and uae kinder which the reference-7ci permit wav 'i nue
Y B ILD INSPECTOR
NUII-p G . FIC:AL
POST IN CONSPICUOUS PLACE
I.tMMMO Na,I-99
City of Tigard Building Departaent
13125 s11 Ball Blvd. Tigard, Oregon "-7223
Inspection Line (Roc-O-Phone): 639-4175 Businen■ Phone: 639-4171
Inspection:, --- -- --
Footing Plbg. Undersiab Mach. Rough-in Appr/sdwlk
Found. Plbq. Top Out vias Lino �I NALs
Pcst/Beam struct. San. sewer Framing -Bldg. �
Post/Beam Mach. Rain Dre.in Insular_ion -Plumb. f
P.l.bg. Underfloor Mater Line Gyp. ad. -Hoch... ../
2V_
Data RPqussts : — I
d
AAdrsse:
Builder: �_—"--�/ }
TFM FOLLOWING COR"C.TIONS ARE REQUIRED: {+
crx
Inspector: Date:
i
APPROVED DISAPPROVE,) —__ APPROVED sUB.f m To APOVE
Call For Relnsp.
I1 P99r-ION_KPITIC6
City of Tigard Building Department
13125 811 Ball Blvd. Tigard, Oregon 97223
Inspection Line (pec:-O-Phone)s 639--4175 Business Phone: 639-4171
Inspection:__ -_
Footing Plbg. Underslab Mach. Rough-in C Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam 9truct. San. Sewer Praising -Bldg.
Post/Beam Mach. Rain Drain InsuIntion -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Koch.
AN —PH
Date Requested: _T►�= _
0
Address:.-_- �� �I Jr�CU l FC _� Permit l�of 0�..
By=lder•_—�(f-i-
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector: L O Dote:
_APPROVED DISAPPROVEDy J APPROVV J SUBJgr'r TO ABOVV
Call For Reinap.
r■MMMMM
NJ SZLC-71 ON.NOTIC6,
City of Tigard Building Departaent
13125 SW Ball Blvd. Tigard. Oregon 9727.3
Inspection Line (Rec-O-Phone)s 639-4175 Business Phone. 639-4171
Inepsctiuni-------------------------.�.___— _� _�,_
Footing Plbu. Underalab Hoch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Cas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line [� Gyp. Bd > n.-ch.
Date Requesteds /n 9% Time: AM _ PM
Address: /3 1 t f 1 )Ci/9r-7/1c) c k- _ P;`rm115t71_1: ')v
Builders C1-t ✓ �/ / £'Y" __ ___+
TBE FO r CORRECTIONS ARE REQUIRED:
LV' --
Lop
Date.•_
APPROVED - -- DISAPPROVED ✓ APPROVED SUBJECT TO ABOVE
-Call For Reinep.
�NSP.CCPION NOTICE
City of Tigard Building Dexwxtsent
13125 81. 3&11 Blvd. Tigard, Oro4gon 97223
Inspection Line (Rec-0-Phone): 635-4175 Business Phone:,639-4171
1_ ,1 I-L C.&',
Inspection:_._,__ _ /fit "4
Rooting Pl.bg. UnderslaL h. Rough-in ppr/Bdwlk
Pound. Plbg. Top Out Gas Wne I t�1IR1►L:
Post/Beam Struct. San. Sewer Framing �j/�7��a -Bldg.
Post/Beam Mech. Rain Drain Insulation (p/l/'i4PILueb.
Plbg. Underfloor Nater Line Gyp. Rd. -Hoch.
Date Requestea. '/! - L1 /_y Tlmet )U1 ___PH
Addreass J' \/ C/1! 7 Permit 911- 01,51
Bu 1 tder t
TNR PorAAMING OORRRCTiIONS ARf R20IRKDo
c -r;
J
4 j, VL,-( --c,4 (b S
To-s or
-q4 TLf
!nspectort _ Date:_ - ze " if
____"PROM �281WPROVtO APPROVED SURiErT TO ABOVE
_ V Call For Rsinap.
INSPF:QTION NOTICE /
City or Tigard Building Departaent
13125 S* Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)e 639-4175 Business Phones 639-4171
Inspections—�_ — —� _—.-------_
Footing Plbr. Underalub Hoch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out one Line FINAL:
Post/Beam rtrvct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain ( Insulation / -Plumb.
Plbg. Underfloor Nater Line oyti.. ad. -Koch.
Date Requested: _—(Q=L / 7 Timet A14 PN
Address:_ I�� 7 �/7✓�C� ( /�.CC' k Pena�fs y
Builder:�,� _F��l�
THE FOLLOWING CORRECTIONS ARE REQUIRED:
I
r�
IrApector: _ Date:� / L
APPROVED DISAPPROVED APPROVED S'-AJXrT TO A
call For Reinsp.
A�
M$ ION MOTICK
City of Tigard Building "tPertawnt
17125 81t Hall. Blad_
Tigard, :'9rogon 47223
Iwpection Lin, arc-O_phone)% 639-4171 Ausknese Phone: 6e171
n
Uudoralab Hoch. Rough-in \ Appr/Sdwlk
Foot i ng F.'1 bg• I
Pound.
Plbg. Top O•at Cas Line lINALe
Post/Beam 3truct. Sen. Sewer raminq -Bldg.
Post/Deem Meeh.
Rain Drain Insulation -Plumb.
Natar Line Oyu ed. -Mach.
Plbg. Underfloor ll
Date Requested:____ OrMi
_ --
Builder:—/2/
THE POLI.OWING CORRECTIONS ARE RyQUIRED:
---------- L ------.��_-`—.—. Dater
Inspectors
APPAOV80 _F DIShPPROVRn APPROVED SURJECP TO ABOVE
Call For Reinsp.
INSPECTION 14TIC$
City of Tigard Building Department
13125 RM Ball Blvd. Tigard, Oregon 972
Inspection Line (Rec-O-Phone: 639-4175 Business Ph 639-4171
Pootinq Plbg. Underelab Mach. Rough--in Appr/Sdwlk
Ponnd. l Plbq. TCP Out Can Line FINAL:
Pos�,Bet^ Struct. San. Sewer Praising -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Uyp. Bd. -Hoch.
Date Requastedc� /� �- �> Tirasi �[��AMM — PH
Address:_ 7—LLL i,./,�)(.) C ('k. L�q'• Pet�i �l! C__1'_
BuUder:�/�(`�/
THE FOLLOWING CJRRECTIONS ARE REQUIRED:
Inepector ��— Date:__ � ?l�
i
APPROVED _—_ DISAPPROVED APPROVED $UR.Y1S_ TO ABOVE
—^Call For Reinap.
OSPE27ION NOTICE
City of Tigara Building Dnmrtsrnt
13125 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line pec-O-Phoneys 639-4175 Businean Phone: 639-4171
Inspection:---- ---- — ---- --- --— ---
looting Plbg. Underslab Mach. Rough-in Appr/Sdwlk
Found. Pl.bg. Top Out Gas Line FINAL:
st_/seas stru San. Sewer Framing -Bldg.
Pon h. Rain Drain Insulation -Plumb.
Plbq Underfloor Nater Line Gyp. Bd. -Mach.
Date Requested: �� 5�!_ J 1 AM
Address: PenyoitQ�/: �L1-
Builder: c /� —:, �z /'�/ / O / 2
THE FOLLOWING CORARrTIONS ARE REQUIRED:
Inspector: Date:
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
INS 8CTION NOTICE
City of Tigard Building Department j
13125 Bw Ball Blvd. Tigard, Oregon 97223 Ii
Inspection Line (Rec-O-Phone): 639-4175 Business Phcnet 639-4171
Inspections_
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
F.wnd. Plbg. Top Out Can Line FINAL:
Post./Beam Struct. Ba�Xewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. underfloor Nater L/ Gyp. Rd. -Meeh.
Date Requested: �) Times
yl_ AN PM
Addross:1y� _ BC�/J�)L� Permit
Builder:
TRE FOLLOWIVG CORRECTIONS ARE REQUIRED:
I
Inspectors
APPROVED DISAPPROVED APPROVED SUBJECT To AROVE
---Call For Reinap.
hSPEC LION_NOTICE
City of Tigard Building Department
13125 811 Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-417S Business Phones 639-4171
InspectLons4._� -_---�
Footing Plbg. Underalab Hoch. Rough-i-s Appr/Sdwl.t
C�� Plbg. Top Out Gas Line FINAL:
Powtt//Beam Struct. San. Sewer FrPAing -Bldg.
Port/Beam Mach. Rain Drain Ins,ilation -plumb.
i
Plbg. Underfloor Water Line Gyp. 8d. Mech.
Date Requeatedt 7,P L
- fir, Ti1Mt AN gM
(�J( l
Address: f Arlt �t �1
Builder: C' (,• JY� )'
THE FOLI.OWI mRRECTIOws AAR RRQUiREDs
i
Inspector:_ _- — Date:
_ APPROVED DISAPPROVED APPROVED SURJECT Tt` BO
__ Call For Reinsp.
INSP ION NOT CE V
city or Tigard Building Department
13125 SW Ball Blvd. Tigard, IVORCM 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phones 639-4111
Inspections_______ _-
Pootlnq - Pibg. Underelab Mach. Rough-in Appr/sdwlk
Plbg. Top Out Gas Line FINAL:
Pont/Beam :,tract. San. Sewer Framing -Bldg.
Post/Ream Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor. Water Line Gyp. Rd. _Hoch.
Date Req.sested. _y � --__TL.. __V -PN
Aidrsss:_ 9 9.!7 /y9r�/)L) 6LCrA_&--Permit
Bulkier: 7' Ik 1- ',25/- &�6r1 ,L pD n THE FOLLOWING—CORPEcTIONS ARE REQUIRED:
(� ) v'VN Zi - "A
-�2c..•--„� �' ���-��'v rte` .�. r, — (� e
Inspector•
__Y_APPROVED _ DISAPPROVED �11PPR117D SUBJECT To RROVE
Call For Reinsp.
PLUMBING PERMIT
CITY OF TIGARD DATE PERMIT
ISSUED: , N4/r_1/94 0151
COMMUNITY DEVELOPMENT DEPARTMENT
19146•w H&H Wd.Tqud, 7429.9199 (W3)639-4171 PARCEL: 2S i 02DD-01800
:SITE ADDRESS. . . : � SW FANNO CREEK DR
SUBDIVISION. . . . : FINLEY PARK .0701 ZONING: R-7
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . kW
:LASS OF WORK. . :NEW GARBAGE DISPOSALS. . : 1
JYPE OF USE. . . . a SF WASHING MACH. . . . . . . al BACKFLOW PREVNTRS. . :N
OCCUPANCY GRP. . :R3 F=LOOR DRAINS. ,. . . . . . :0 TRAPS. . . . . . . . . . . . . . :0
STORIES. . . . . . . . :2 WATER HEATERS. . . . . .
: 1 CATCH BASINS. . . . . . . :@ I
FIXTURES---------_---_- LAUNDRY TRAYS. . . . . . :0 SF RAIN DRAINS. . . . . : 1
SINKS. . . . . . . . . . : 1 uREAGE TRAPS. . . . . . . a0
LAVATORIES. . . . . :4 OTHER FIXTURES. . . . . :0
TUB/SHOWERS. . . . : SEWER LINE (ft ) . . . . :0
WATER CLOSETS. . :3 WATER LINE (ft ) . . . . : 100
DISHWASHERS. . . . : 1 RAIN DRAIN (ft ) . . . . :0
Remarks : PATH I
OWNER: -_____.______---._.__._,_.,_________ ------------------F'EES-••___-___-__------
JAY MILLER TIF $ 1520. 00 SW 04/21/94 -
P 0 BOX 23291 BPRT $ 448. 00 SSW 04/21/94 -
BPLC $ 291. 20 SW 04/'15/94 94-521319
TIGARD OR 97281. 85PC $ 22. 40 SW 04/21 /94 -
Phone #: 684-7543 SSDC $ 281. 00 SW 04/21/94 -
PORK $ 500. 0e SW 04/21/94 -
P'lumbing Contract or: ___________-._..____ MPRT $ 45. 00 SW 04/21/94 -
�. MPLC $ 11. 25 SW 04/21/94 -
Name:��.l b. - 1,�+.�.�+1 4 .____ __.�. M5PC $ 2. 25 SW 04/21/94 -
Nddress: PPRT $ 140. 00 SW 04/21/94 -
CitY= ._ _.� State :____ —_ P5PC $ 7. 00 SW 04!21/94 -
Zip: ^_ Phone#: _
Req #:
-- ----- REQUIRED INSPECTIONS
Phis permit is issued subject to the req-
ulations contained in the Tigarc' Municipal Foot/found Insp Rain 'train Insp
Code, State of Ore. Specialty Codes and all Post/Beam Str'_tict Water Line Insp
ether applicable laws. All work will be done Post/Beam Mechan Appr/Sdwlk Insp
in accordance wi"h approved plans. This Plm/undslah Insp Mechanical Final
pprmit Nill expire if work is not started PLM/Underfloor Plumb Final
within 180 drays of issuAnre, or if work is Mechanical Insp Bui :.rjing Final
sklspend4,d for more than 180 days. Plumb Top Out Erosion Control
Framing Insp Crawl Drain
r Fireplace Insp _
/ Gas Line Insp
Insulation Insp -
r y P Board Insp
A'i.tthoriaed Plumbing ContractorSignature
Call for inspection - 639-41.75
C:'ontrActor Notes: --
RMI
CITY OF TIGARD PERMITS#TER. ... . : MST94-0151
COMMUNITY DEVELOPMENT DIPARI MENT DATE ISSUED: 04/21/94
13196 8W Hag NOW.Tlpvd,Ornon 97223x8199 (603)630.4171
13975 PARCEL: 2S 102DD-4"11TW
SITE ADDRESS. . . : •#-896 SW FANNO CREEL; UIR 0/ 700
SUBDIVISION. . . . . FINLEY PARK 001 ZONING: R-7
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . b~.
--------------------------------- BUILDING
REISSUE: DWELLING UNITS: 1 BASEMENT :0 sf
CLASS OF WORK. :NEW BEDRMS:4 BATHS:3 GA RAGC:. . . . . . . . . . :42LN sf
TYPE OF USE. . . :SF FLOOR AREAS----------- REOU I RED SETBACKS----------
TYPE OF CONST. :5N FIRST. . . . : 1020 sf LEFT. . : 10 ft RIGHT. :6 ft
OCCUPANCY GRP. :R3 SECOND. . . : 1100 sf FRGNT. :20 ft HFAR. . : 16 ft
STORIES. . . . . . . ..2 THIRD. . . . :0 s f REQU I
HEIGHT. . . . . . . . :24 ft TOTAL------:2120 sf SMOKE DETECT'GRS. :Y
FLOOR LOAD. . . . :40 p.f VAL.UE. . . . . $: 105080 PARKING SPACES— : 1
Remarks : PATH I
__._-----------_______----------___-.- PLUMBTNG - --------------------------------------
SINKS. . . . . . . . . . : 1
-_.-_.-_.___---------------SINKS. . . . . . . . . . : 1 FLOOR DRAINS. . . . :0 BACKFLOW PREVNTRS. . :0
LAVATORIFS. . . . . :4 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . :0
TUB/SH04v�RS. . . . :2 LAUNDRY TRAYS. . . :0 CATCH BASINS. . . . . . . :0
WATER CLOSETS. . :3 SEWER LINE �'ft ) . :0 GREASE 'TRAPS. . . . . . . :0
DISHWASHERS. . . . : 1 WATER LINE tft ) . : 100 OTHER FIXTURES. . . . . :0
GARBAGE DISP. . . : 1 RAIN DRAIN (ft ) . :O
WASHING MACH. . . : 1 SF RAIN DRAINS. . : 1
---._-_-_-____----- MECHANICAL .___-----_--.-_---_.-.___.-_--- -w-- FEES
FUEL TYPES-•-----______._- UNIT HTRS. . -.0 type amount by date rec.pt
/GAS/ / / VENTS . . . . :0 TIF $ 1520. 00 SW 04/211/94 -
MAX INPUT:O BTU VENT FANS. . :h BPHT f 448. 00 SW 04/21/94 -
FURN 1100K . . :0 HOODS. . . . . . : 1 BPLC t 291. 20 SW 04/15/94 94-521319
FURN >- .00K . . % 1 WOODSTOVES. :0 B5PC $ 22. 40 SW 04/21/94 -
FLOOR FURN. . . . :0 CLO DRYERS. : 1 SSDC f 280. 00 SW 04/21/94 -
BOIL/CMP ( 3HP:0 OTHER UNITS: 1 PPRK f 500. 00 SW 04/21/94 -
GAS OUTLETS: 1 MPRT t 45. 00 SW 04/21/94 -
Owner: ----------------------------------------MPLC; $ 11. 25 SW 04/21/94 -
JAY MILLER M5PC f 2. 25 SW 04/21/94 -
P 0 BOY, P-3291 PPH T $ 140. 00 SW 04/21/94
P5PC S 7. 00 SW 04/21/94 -
TIGARD OR 9.7281
Phone #: 684--7543
Contractor: - _______._.___..________._.__-_-----
Jf�Y MILLER
PO BOX 23291.
'fIGARD OR 97281
Phone #: 684--7543
Peg #. . . :30109 -------------------------------- -------------
$
----•-----
$ 3267. 10 TOTAL.
This persit is issued subject to the regulations contained in the ------- REQUIRED INSPECTIONS -- -- ---
Tigard Municipal Code, State of Ore. Specialty Codes and all other Foot/found Insp Fireplace Insp
applicable laws. All work will be done in accordance with approved Post/Beam Struct Gas Line Insp
plans. This persit will expire if murk is not started within 18@ Post/Beam Meehan Tn,,ulation Insp
days of issuance, or if work is suspend@ for sore thV@ d;,-i,. Plm/Undslab Insp Gyp Hoard Insp
/ PLM/Underfloor, Rain drain Insp
f,ermittee 9ignatf_1re : - Mechanical Insp Water Line Insp
l 1111_imb TOP Out Appr,/Sdwlk Insp
Issued Py ; lJ framing Insp Mn,'I r ,rir_.al Final
Gall for inspection - 639-4175
SEWER CONNECTION
PERCITY OF TIGARD PERMIT 0. . . . . . . SWR94-0155
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 04/21/94
13176 SW Hall Blvd.Tigard,Oregon 07223.8109 (603)639-4171
/39 P5 PARCEL: 102DD-914-BQb
:iT'TE ADDRESS. . . : t-396-7 SW FANNO CREEK DR 10/700
SUBDIVISION. . . . : FINLEY PARE ZONING: R-7
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . .
TENANT FAME. . . . . :
USA NO. . . . . . . . . . FIXTURE UNIT,S. . . .
C:Ln- SS OF WORK. . . :NEW DWELLING UN I'TS. . : 1
TYPE OF USE. . . . . :SF NO. OF BUILDINGSs1
INSTALL T'YPE. . . . ;BUSWR IMPERV SURFACE. . : :s-F
Riemalrks: PATH I
Owners ----- —_.._________.___.__._..___.____._._.____--------..___._______-- 'EES
JAY MILL_E.R type ramoo.Ant by date rer_pt
P 0 BOX 2:3291 PRMT $ 2200. 00 SW 04/21/94 —
INSP $ 35. 00 SW 04/21 /94 —
'TIGARD OR 97261
Phone #: 5$4•-7543
Contractor: —__._____________.. _----• ----•-•-____-.
CONTRACTOR NOT ON FILE
Phone #: $ 2235. 00 TOTAL
Reg M. .
------ -- REQUIRED INSPECTIONS
-- — -- -
This Applicant agrees to comply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The permit expires IN days from
the date issued. The total amount paid will he forfeited if the
perrit expires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not located at the aeasureaent
given, the installer shall prospect 3 feet in all directions from
the distance given. If not so located, the installer shall purLha,;e
a "Tap and Side Sewer' Permit and the Agenc will inst 1 lateral.
Pel•mittee 5ignatUre:
Call for inspection - 6.39-4175
Cll'y OF I )GORD cm: PAYPIFNI RECEIPT MCI. a94--P5,1564
CNIFC K APID(.IN't a 5e°5(?- I W
1AME a JAY MILL LR FILDR CASH AMOUN,,r.
PAymFNT' DATF
41)DRESS 0 � /94
slifiDIVI SION
:,I)RPOSE (IF' r-'lAYMFN'r APIOUNI, PAID PURPOSE. (IF p-A yME N T AMClUNr PAID
..............
-0.1ILDIN13 PERM M91-94-0t5i 448.00 PI-11MBING PF.RM 14171«00
1C.CHANICAL PU 45. (40 (,'T. POILD PFN 31. -E,5
5 R. 4 5 (414ER USA SWR94 0 1.55 2200.00
I AN CHECK VE
lH9V't--C,'t 34t. (40 PRRKS ',-%I)C bff). V)IA
DRAIN f3l)(1, V80. (40 NF-J-31D.!NT TOL TRAFFIC FF.F.S 141.0. 00
AS'S TRANST T 11F FFFS 110.00
x4f.45 SW FONNI'l CRERK DR/LWT #1
1*OTAL AMOUN't PAID
s
Residential Building Permit Application
City of Tigard
1.3125 SW Hall Blvd. `f
Tigard, OR 97223 C
(503) 629-4171
.lobsite Address: ��� ✓1 �
' V.7v VII t
f Subdivision: 1 n 1 i_ K— Lot#
valuation /6'sQSLdi
< u
6 4
owner: Y
(( 1elu
Addre'VI _
Phone:
C/
Contractor:
t
Address:
• / ,, ( — k. , .fix
Phone:
Contractor's License tl
(attach copy of current Oregon license)
Subcontractors:
J Pp,mbing: 4,4'AI/ � bw_ �
JMechanical:
(attach copy of curnen R Contractor's License)
Arch!teci ngin r: _
Adds 9ss:
Phone:
Applicant Signa u e & Phone number
Received by: Date Received: ' S
i
U
Y
Permit 0 Account Description Amount Amt. Pd. Bal. Due
his f y -0 'S Bldg. Permd (BUILD) ANY 1 U J
Plumb. Permit (PLUMB) Ivo,o /�U
Mech. Permit (MECH) _ v0 'mrd✓
State Tax (TAX)
Plumb: :7, O o
Mech: ✓
Plan Check (PLANCK) r,2,�/ Z 'S�� �S Z, c/S
Bldg: J /, Z u
Plumb:
Mech:
Sw k,57jp I S, Sewer Connection (SWUSA) ZZUU ?uU
J
Sewer Inspection (SWINSP) 35 3>;
Parks Dev Charge (PKSDC) —5 o 0 / 5 6G 0 W
Storm Drainage Chg (SDSDC) 0-8U Za�u VV
Residerdlal TIF (TIF-R) 1410 /U
Mass Transit TIF (TIF-MT) //0
//(; ✓
Com:nerciai TIF (TIF-C) _
Industrial.TIF
Institutional TIF (TIF-IS)
Office TIF (TIF-0)
Water Ouality (WOUAL)
Water Quantity (WOUANT)
Fire District (FIRE)
TOTALS:
„"�+N-ter.--s.^.'-ti --�.-�a-�.-�-..-v--••�----•-•- -•..-�.--..-�..---+--�w-�.--•---•-.--�.--.--.-_'vr-..--.r--•w�-•-�.-..- .. -.--: •-'-- .-- ---'r
u i 1
CITY OF 110ARD RF;(:F.-TVIT OF PAYMFNI' RFCF.:1:F'T 40. a'3Q.—P..913i.9
C HEC.'K AMOUNT u i.?(5”, 00
A11F.. a M[L.LF Rv JOY C:ASIA AMUUN 1 a 0.00
11►1)C�;F't f3 a PAYMENT DA•I F. a 04/15/9.4
'.i1.18I)'14VJA1ON a
"11PPIOSE: OF: VlAYME:NT AMOUNT r-"OtD P1.112PIOSE (.)F mYI•IE:N 1 AMC)UNI PAII3
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