12415 SW MAIN STREET 12415 SW MAIN STREET
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CITY OF TIGARD Plumbing Permit -1
Building Department No.
Residential commercial
New installation Replace Addition ❑ Alteration Date
Licensed
Plumber 4 L/ Owner
Address % )"S' Job Address Z24
Phone R Applicant
CITY BUSINESS LICENSE REQUIRED,OR ALL CONTRACTORS AND SUB-CONTRACTORS
ITEM- NO. FEE TOTAL ITEM NO. I FEE TOTAL
Fixtures-Traps 7.50 —0 0 Sewer:First 100 ft. 30-00
Dishwasher 7.50 Each Addit.100 ft. 15",0
Garbage D!sposal 7.50 Elector Pump 7.50
Water Heater 7.50 Water:First 100 tt. 20.00
.Backtlow Preventer 7.50 Each Addit.200 ft. 15.00
Storm&Rain Drain:First 100 ft. 30.00
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Each Addit.200 ft. 15.00 .la
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Mobile Home Space 25.00
Other Vpecify): Rain Drain-Single Fam.Dwelling 15.00
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PERMIT FEE Comments:
110 issued By:
STATE % "IT
LV
Receipt No. Applicant
TOTAL _��] SIgnatum
For Plumbing Inspection Phone 639-4 1171
Address l yl� /J.5 w P/ao, Permit No.— /O ?
Pei mit: charge ,
Owner Connection fee 7
Paid by�
Type of Building Date connected
Service Kate Tnspection fee
Contractor — Paid by (La _Date
Size of connection-� _ Assess��ientY, Paid
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PERMIT To CONNECT
Tigard Sanitary ]District
PERMIT r1l 9 1097 DATE �f kr l• G.�
PERMIT IS GIVEN TO
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITART DISTRICT
AT
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THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN CrJM-
PLFTED.
PERMIT FEE PAID ;.!__ ..�......................TIGARD SANITARY DISTRICT
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By
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CONNEcrioN INSPECTED AND APPROVED
Date Superintendent
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