14445 SW FERN STREET i
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14445 SW FERN STREET
TAN-13-1900 09:07 FROM TO 664?297 F.U""
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10643 N.E.Simpson INVOICE compl•le
Portland.Oregon Induatrlal
97220 waste
Removal
Septic tbnk ciesnlnq
j sump
j Line Cleaning
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ASA141TATION 027482
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i DnA McInnis F.W.Lid,Co.
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(503) 253-7587 ( i
Customer P.O. #r _ ___Djtte.___--- _-•-�_• E_--- _
i Billing Name :,1 .IWA PA 'A I•C I)i
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Address t is
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Job Site# ._....-----��_
CityZip Code.
Ordered
ode.Of+dered 6y e �4 �. Date
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Job location__.��la��/,5.,5 w. F H b .•x{,�h ?11
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' Service Call ---
j labor
Pumpinggallons.
MConditions of tank/Distribution
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TOTAL CHAR
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Schutt Senrtstion Is In no way responsible for d>tmage to the septic tank or II on the system.
TERMS;Net to days.t'lv%.per rnontfo will be Charged on past dup accounts.{
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Customer's Signature:
Service Driver's Sigrta urb ! Time . bate��Z�.%4
TERMS AND CONDITIONS ON REVEnSEb of RE"661�MA9t-E IN MULTNOMAH COUNT.
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CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
'13125 SW Hall Blvd. Tigard,Oregon 97223.8199 (503)839-4171
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f'I. OOP AREW; i (:Tf)` W 'lI...t.. (:ON")TRUCT
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RN"I' I ,. Ft ' ' 1111LR`v' 1INDICIP Hl.i
I I,.17, .aR 1:'.x.1_ . ( � f r;IK!'.I!
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Residential Building Permit Ap lication
City 'igard
1312 SW Hall Blvd.
Tigard, OR 97223 EM0 L I T I UNI
(503) 639-4171 -
Jobsite Address:
Subdivision: t1L1/ tr%,� �' Lot# Office Use Only
Valuation: Planck/Rec #
Corner Lot? Y L� Permit# ����17 � , C)[!a [�
Flag Lot? Y o -) Reissue of
Map & TL#
Owner: $/EAUAf t`A< fF"� Z1tVELj>10rk1F.r07— Approvals Required
Address: >_0 /w� /> Planning
�,•{�_E �U/� 70.3 Engineering
Phone' / q - / '7.� -- Other
Contractor' L . 7. ���1.tdiiCsQi.� �v►1 Items Required
ired
Address: Ed Z 206 3� _ Subcontractors
ri�2. Truss Details --
Phone: Other
Contractor's lice.ise # _ (9.S VLv
(attach copy of current Oregon license)
Contact Name & Phone: Zeds
Subconiractors: Architect/Engineer:
Plumbing. '� -_ Address'.
Mec.nanical: ✓t'� �"' _ __ _ _
(attach copy 4current OR Contractors License)
JOB DESCRIPTION: %�
Applicant Signature ho umber
Rec� ved by: x �' . �� — — Dd'e Received:
Permit# Account Description Amount Amt. Pd.
Bldg. Permit (BUILD)
Plumb. Permit (PLUMB) _
M�ch. Permit (MECH) _
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State Tax (TAX) _
Bldg:
Plu b:
Mech
Plan Che4k (PLANCK)
Bldg:
Plumb: _
Mech:
Sewer Connection (SWUSA)
Sewer Inspection 'W,II+�SPj
Park ; Dev Charge (P DC)
Residential TIF (TIF-R
Mass Transit TIF (TIF-MT)\,,
Commercial TIF (TIF-C) \\
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS)
Office TIF (TIF-O) _
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT)
Erosion Plar.ck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS:
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