13071 SW MERLIN PLACE aOe1d UIPON MS �LO£L
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13071 SIN MERLIN PL
Mar 13 01 OStOOr TRC Exoavat:ing, Ina. SO7-C74-8b7P_ *• t
TRC EXCA VA TIN®r INC *U.OM 3244
1'a Whom it trrty CCMZ .
The p,0awieg is briddeMiptlon of the stOrm tie in On WIdk*Y 11 a1 the BM%70*ow
Quail k1oeow eke. We extern'-4 the h%ch pipe 01mVi g to ASS at the Qt nWCtisn. From A*
Femoro connWim we rat the pipe up towards tha buUng with a wye off to the left for the 8°oni
min drains foliowmed Ir,'a wy+e to the t*M Mr the"t.*drain malting sure that thmc was Wwwfl
a pomkiw now. l f y t,have any quetinns pkw Call me at 543-577-4293.
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CITY OF TIGARD BUILDING INSPECTION DIVISION MST -
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
NUP
644--Date Requested—J3 1-q _ AM .—PM BLD
1n — -
Location /?5071 10 /(.x ' Suite _ MEC
Contact PersonLnY, Ph PLM
Contractor Ph SWIR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Access:
Foundation FPS s
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab — SIT
Post&Beam `-
Ext Sheath/Shear
Int Sheath/Shear
Framing .-----_-.-
Insulation
Drywall Nailing _-_ �-"> �_r __._ ___.___-.__.
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling —
Roof
Misc:_
Final ____-------
PASS PART FAIL -- -- --- -- — --
PLUMBING
Post&Bean- _��---- ---�-- --
Under Slab ---------- --__ —
Top Out
Water Service
Sanitary Sewer -----�—_.___--- --
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post&Beam -- -- — - -----
Rough In
Gas Line --- -—-
Smcke Dampers
Final -
PA RT FAIL
IL Service
& Rough In
N UG/Slab
Low Voltage
Fir
J in i
m PART FAIL -
W Backfill/Grading - - ----- ___ _---
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ required before nevt inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ]Please call for reinspection RE: [ ]Unable to Inspect-no access
ADA �� `/i7
Approach/Sidewalk Date J - /
Other 9` Inspector _ Ext
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION .DIVISION'
24-Hour Inspection Line: 639-4176 Business Line: 639-417'
SUP
_Date Requested 3 - Z— AM �!� PM SLD
Location /_3o ?/ SL., &-e-t k H f2 Suite MEC
Contact Person Ph 7f�. '4--5 7 7�
Contractor Ph TnSWR ;
_ Tenant/Owner ` ELC
Retaining Wall ELR �—
Footing Access:
Foundation FPS _
Ftg Drain SGN
Crawl Drain Inspecti n Notes: - —
Slab _ ___ SIT _
Post&Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing -
Firewall
Fire Sprinkler ---
Fire Alarm
Susp'd Ceiling
Roof
WFinal DLA ��wf
SS PART FAI
Post&Beam
Under Slab
Top Out y,I _ ��
Water Service ,3. f"y'�-�,/
SanDSewer �y, ate_ �, _a� 1
Rain ►sina
ina /
PASS PARI A ��G
SS ---- ���
Post& Beam
R"h In
Gas Line
Smoke Dampers Cz� � � do
(tWSW PART FAIL re;t^ y�)
CTRICAL —II
a Service
Rough In
'JG/Slab p11 `� JL �4 ..�/►���
Low Voltage�l1 (� /+
Fire Alarm
J Final
m SS RT FAIL
SI
W 4r
"j ckfill/Grading -
Sanitary Sewer r� bl r`_ _�*^-* (�
Storm Drain �6' ( ]Reinspection fee of$ _ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin 1�I „O� ( ]Please call for reinspection RE: [ J Ur.able to Inspect-no access
Fire Supply Line V1 --
ADA
roach/Sidewalk date y Z U� Inspector y t� '�'"" Ext��
0th �_/ '_ �tAm —
F� A3 PART FAIL DO NOT REMOVE this Inspection record from the job site.
CITY OF TTGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 6394175 Business Line: 639-4171
BUP
_Date Requested AM /,-"-' PM OLD
Location1,3o •7 1)9-yt // ,, )21 Suite _ MEC i
Contact Person i� Ph PLM
Contrac'x _ Ph -_ _ SWR
fLUI - Tenant/Owner _ _ ELC —
Retaining Wall ELR _
Footing Access:
Foundation FPs
Fig Drain SGN
Crawl Drain Inspection Rotes:
Slab _ _ SIT
Post$Beam --
Ext Sheath;Shear _
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
-i
ASS PART FAIL -----• — — ---�-- —
Post&Beam --
Under Slab
Top Out
Water Service _
Sanitary.SewQQr, r)��1 __
Rein Draint)L+r t(R
r
PAS PART FAIL
REVIIANICAL
Post&Beam
Rough In
Gas Line —
Smoke Dampers
(,,A,Lrinal
PASS PART FAIL
ELECTRICAL -
IL Service
Rough In
UG/Slab
Low Voltage
Fire Alarm _—
a (1h. final
m PASS PART FAIL
C7 SITE
J Backfill/Grading
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ required uefore next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ )Please call for reinspection RF:_ [ ]Unable to inspect-no serosa
ADA _
Approach/Sidewalk , '
Other Date _ Inspector Ext
Final
PASS PARL__EAIL_j DO NOT REMOVE this Inspection record from the job alto.
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CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
CROMWELL PLUMBING
306.5 S KAUFMAN RD
CANBY, OR 91013
Plumbing Signature Form
Permit#: MST2000-00257
Date Issued: 8!15!00
Parcel: 2S104DA-12400
Site Address: 13071 SW MERLIN PL
Subdivision: QUAIL HOLLOW -WEST
Block: Lot: 110
Jurisdiction: TIG
Zoning: R-4.5
Remarks: SFD - Rowhouse - Lot 110 - Plan C-NB - Setbacks as per site plan
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return
this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Dept.
No plumbing inspections will be authorized until this completed fond is received
OWNER: PLUMBING C-)NTRACTOR: ,
UIoIeeTi' P1uM#irx.
BROWNSTONE HOMES LLC PO f3oX- Uv-7
12670 SW 68TH PARKWAY Q ^ o1 '77(,31)
PORTLAND, OR 97223
Phone #: 50?-598-7565
Phone #: I �3'�'�~ 170�
a
Reg #: LIC
N PIM Z
m AN INK SIGNATURE IS REQUIRED ON THIS FORM
W X '7
uttiUdzad Plumber
If you have any questions, please call (503) 639-4171, ext. # 310
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
B'JP
—Date Requested_ _// AMPM __— BLrj _
Location z 3o:& -c, rl Suite MEC -4
Contact Person Ph PLM
Contractor Ph SWR
BUIL DING Tenant/Owner ELC
Retaininc Wall ELR _
Footing Access:
Foundation FPS _
Ftg Drain
Crawl Drain Inspection Notes: SGN —-- --
Slab
Post&Beam - - -
Ext Sheath/Shear
Int Sheath/Shear ----
Framing
Insulation
Drywall Nailing _ -
Firewall -
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof Q
Final
PASS PART FAIL
PLUMBING
Post&Beam -- -
Under Slab
Top Out ---
Water Service
Sanitary Sewer -� --- -- -
Rain Drains
Final —'
PASS PART FAIL
MECHANICAL
Post&Beam - ---
Rough ;n
Gas Line - —
Smoke Dampers
Final — - -- --
PASS PART FAIL
ELECTKICAL ---- --
a Service
FE Rough In
�
LIG/Slab
Low Voltage
Fire Alarm
Final
m PASS PART FAIL
C7 SITE
JBackfill/Grading - --- —�- — ---------
Sanitary Sewer
Storm Drain [ ]Reinspection fee of S required before next Inspertion. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin Please call for reinspection RF'
Fire Supply Line [ ] P -- [ ]Unable to inspect-no access
h/Sidewalk pate �'-�6'Q -- Inspector Ext
Fi
A s PART FAIL DO NOT REMOVE this Inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION / Iles /A"110 -
24-Hour Inspection Line: 639-4175 Business Line: 639-4171( 0!1 )
_ BUP
Date Requested M PMI !/ BLD
LocationO S r Suite / MEC
Contact Person Ph „213 - s 7 7 g PLM
Contractor � Ph SWR -
UILD Tenant/Owner ELC _ _--
Rfining Wall ELR —
ootl Access:
Foundation FPS
Fig Drain - _ SGN
Crawl Drain Inspection (Votes: --
Slab _ - SIT
Post&Beam _
Ext Sheath/Shear I
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler f�S T _ �L _— _ � �L�- ►_
Fire Alarm
Susp'd Ceiling 1
Roof
F'
0--AWS-) ;,ART JIF —-- --- —
ING
Post&Beam
LinderSlab
Tap Out —
Water Sen,ice
Sanitary Sewer — ------_ ----- --______.__ _-- _
Rain Dr3ins
Final
PASS PART FAIL
MECHANICAL
Posi& Beam -------_....____�------ --._.--- ---
Rough In
GasLine ------ —---- -----— -- - -- --
Smoke Dampers
Final ---
PASS PART FAIL
4. ELECTRICAL
Service
1- Rough In
U) UG/Slab
Low Voltage
,j Fire Alarm --
m Final
�j PASS PART FAIL
W IT
a
Backfill/Grading ---- ---`—
Sanitary Sewer
Storm Drain �I/h [ ]Reinspection fee of$—____,required before next inspection. Pay at City Nall, 13125 SW Hall Blvd
Catch Basin ' Please call for reinspection RE: __ [ ]Unable to inspect-no access
Fire Supply Line ] p ----
AUA / A
A aac /Sidey alk < 8te / Z ��� p �� �'~ (e
Ins ector Ext3 I
Fi
S PART FAIL DO NOT REMOVE this Inspection record from the Job site.
CITY OF TIGARD
13126 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
STREAMLINE ELECTRICAL
6017-B EAST 18TH STREET
VANCOUVER, WA 96
L'ectrical Signature Fc rm
Permit#: MST2000-00257
Date Issued: 8/15/00
Parcel: 2S104DA-12400
Site Address: 13071 SW MERLIN PL
Subdivision: QUAIL HOLLOW -WEST
Block: Lot: 110
Jurisdiction: TIG
Zoning: R-4.5
Remarks: SFD - Rowhouse - Lot 110 - Plan C-NB - Setbacks as per site pian
Your company has been indicated as the alectrical contractor for the permit indicated above. In order for the
electrics; ;permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company -*ign below and return this Electrical Signature Form pror to the
start of the work to the address above,ATTN: L'uilding Dept.
No electrical Inspections will be authorized until this completed form :Z; received
OWNER: ELECTRICAL CONTRACTOR:
BROWNSTONE HOMES LLC STREAMLINE ELECTRICAL
12670 SW 68TH PARKWAY 6017-B EAST 18TH STREET
PORTLAND, OR 97223 VANCOUVER, INA 98
Phone #: 503-598-7565 Phone #: 360-993-5080
Req #: LIC 116514
ELE 34.4320
d SUP 219iS
F-
AN INK SIGNATURE IS REQUIRED ON THIS FORM
J
Signature of Supervising Elec ricf c ian
If you have any questions, please call (503) 639-4171, ext. # 310
CITY OF T I G A R D _ MASTER PERMIT
PERMIT#: MST2000-00257
DEVELOPMENT SERVICES DATE ISSUED: 8/15100
z4 13115 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171
,,),'TE ADDRESS: 13071 SW MERLIN PL PARCEL: 2S104DA-12400
SUBDIVISION: QUAIL HOLLOW -WEST ZONING: R-4.5
BLOCK: LOT: 110 JURISDICTION: TIG
REMARKS: SFD - Rowhouse - Lo! 110- Plan C-NB - Setbacks as per site plan
BUILDING
REISSUE: STORIES:~ 3 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 26 FIRST: 324 of BASEMENT: of LEFT: SMOKF DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 747 of GARAGE: 410 of FRONT: PARKIMG SPACES:
TYPE Oil CONS I: 5N DWELLIP G UNITS: 1 FINBSMENT: 557 of RIGHT.
VALUE: f 123,1979A
OCCUPANCY GRP: R3 eDRM: 3 BATH: 3 TOTAL: 1,62000 of REAR:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIE.: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
T' 1I3HOIN�RS: GARBAGE DISP: 'iVmER HEATERS: WATER LINES: RCKFLW PREWITR: ORFASE TRAPS:
OTHER FIXTURES:
MECHAN":AL _
FUEL TYPFS TURN<10i POILICMP<3HP: VENT FANS: CLOTHES DRYER:
FURN-110i UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS,
ELECTRICAL
nESIDI€NnAL UNIT_ SERVICE FEEDER TEMP SKVCIFl5DERS BRANCH CIRCUITS r MISCELLANKJS ADD'L INSPECTIM
1000 SF OR LESS: 0 - 0 amp: 0 200 mp WISVC OR FOR: PUMPARRIGATION: PER INSPECTION:
EA ADC-'L 0003r: 201 At I amp: 201 406 ro tat W/O SVC/FDR- SIGNIOUT LIN LT: PFR HOUR:
LIMITED ENERGY: 401 -600 a,no: 401 600 am EA A not.BR CIR: SIGNALIPANEL: IN PLANT:
MANU HWSVCIFDR: 601 • 1000 amp: 6011-amoa loot•: MINOR LABEL:
1000+amptvoh:
_ PLAN REVIEW A'-'ION
R.comooct only:
�-4 RES UNITS: SVCIFDR?-274 A.: 600 V NOMINAL: CLS AREAISPC:OCC:
ELECTRICAL-RESTRICTED E 4ERGY
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO S STEREO: VACUUM SYSTEM: AL :: 6 STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEARRIG: PROTFCTTVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMIiV rATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL E SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 2,946.62
This permit is subject to the regulations Contained In the
BROWNSTONE HOMES LLC BROWNSTONE HOMES,Lt C Tigard Municipal Code,State of OR. Specialty Codes and
12670 SW 68TH PARKWAY 12670 SW 68TH PKWY all other applicable laws. All work will he done In
PORTLAND,OR 97223 PORTLAND,OR 97223 accordance with approved plans. This permit will expire If
work Is not started within 180 days of isruence,o1 if the
' work is suspended for more than 180 days. ATTENTION:
1 Phone: Phone: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set
Rep 0: LIC 124627 forth in OAR 952-001-0010 through 952-001-0080. You
i may obtain copies of then rules or direct questions to
� OUNC by calling(503)246-198''.
REQUIRED INSPECTiONR
1 Sewer Inspection Mechanical Insp Shear Wall Insp Rain drain Insp Electrical Final
Foundation Insp Plumb Top Out Exterior Sheathing Insf Roof Nailing Mechan!cal Final
Slah Insp Electrical::eMce InsUlatlon Insp Water Line Insp Plumb Final
Under^ooir Insulation Electrical Rough In Gyp Board Insp Water Service Insp Final Inspection
Pim/undslab Insp Fram!ng Insp Firewall Insp Appr/Sdwlk Insp
Issued Bit : _ Permittee Signature I:j
Call (1;3)639-4175 by 7:00 p.m.for an inspection needed 4 ext business day
CITY OF TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2000-00206
13125 SW!call Blvd.,Tigard,OR 97223 (503)639-4171 DATE ISSUED: 8/15/00
PARCEL: 2S 104DA-12400
SITE ADDRESS; 13071 SW MERLIN Pt.
SUBDIVISION: QUAIL_ HOLLOW-WEST ZONING: R4.5
BLOCK: LOT: 110 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SFA NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: SEWER CONNECT FOR NEW SFA
Owner: -- -- FEES
BROWNSTONE HOMES LLC Type By Date Amount Receipt
12670 SW 68TH PARKWAY —
PORTLAND,OR 97223 PRMT RCP 8/15/00 $2,300.00 0004505
INSP RCP 8/15/00 $35.00 0004505
Phone: 503-598-7565 Total $2,335.00
Contractor:
Phone:
Reg M
Required Inspections _
Sewer Inspection
IL
m
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires
ILI 180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not
guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement giver.,the installer
shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a"Tap and
Side Sewer' Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling(5n.. 246-1987.
�^ n Permittee SI natu
Issued by: J_�O , g , "
nall03)639-4175 by 7:00 P.M.for an Inspection need the xt business day �.
CITY OF TIGARD Residential BuOding Permit Application Plan Check If- 7-26 �.
—
1,3125.SW HALL BLVD. New Construction Reed By_Date Recd -Of7^
TIGARD, OR 97223 Single Family Attached Date to P.E` -00
V 503-639-4171 Date to DST
F 503-684-7297 L Pem,itaN15 Za�s�o �^is7
Print or Type called--7DM_Msl
Incomplete or illegible applications will not be accepted
------ 1 - -7 I,J 1Z 00 Z o�
Name of Project Nage
Job urs► I ���tl o�J_w4et -� . . ---
Mill
AddressSite Architect �i !Adyd,�-rerosis
�,ddress �!�-7l ijUJ v
^ �VG
ame
CJtY/StateZip Phone
Owner ling Address NM.
--Qe Engineer M�a),III n.�,Address
it !State Zio�� P}io11Q '�� I �iJ Ni�7eJ5 R✓�
Cj ��jt�� Isla Zi Phone General (Nan,P _ �ir_t: 9nz lm3p9 33
Contractor `4fiAJM Wd NmAL*S LL(-- Describe work New Addition O Alteration O Repau O
Mailing Addresspp to be done:
Prior to permit -70 lostj lA'2ic Aq Additional Description of Work:`�� �_b�-
issuance,a copy ity/Slate Zi P ne _-- ___—_ TW3`AC*4li;
of all licensesIt-au aA)p 0116 s�
are required if Oregon Const.Cont.Board Exp.Date PROJECT _
expired in COT LicIA Qti-Ir"-b0 VALUATION $ _
database 1. -1 _-—
Mechanical Name NEW CONSTRUCTION ONLY:
Sub- foul-c t-7ft iiia fr,Aoxrlmcl Sq. Ft. House: I Sq. Ft.Garage,/O
Contractor Mailing Address
Indicate the restricted energy installation by the electrical
Prior to permits , � subcontractor in the followin areas
issuance,a copy Ci /State Zip Phone --
� Restricted— Audio/Stere-
of all licenses
T- OM 97Z]� 775-9"f/
are required if Oregon Const Cont Board Exp.Date Energy System I Alarms
expired in COT Lic a �a �G�DO Installations Vacuum Irrigation
database_ _ _ System _ System
Plumbing Name (check all that Other:
Sub- CQjP)%u--4-'t 1 Ylu Akf6l � ; S - ° i _ -
Contractor Mailing Address Number of Units in Building Unit.Number Designation
Jlwuen'*•v 1211 Has the Subdivision Plat recorded? N/A YDS NO
Prior to permit City/State �y.- Zip Phone VV
issuance,a copy gy CQF- 1L')1 3 ?.G6•
of all licenses are Oregon Const Cont.Board Exp.Date
required it Lic
expired in COT 44711, 1 hearby acknowle.d t a I have read this application,that the
database Plumbing Lic # Exp.Date information given is orr, t,that I am the owner or authorized agent
of the owner,andith t pt. s submitted are in compliance with
Ore to la
Name Sig6alIliire of O r/ g n f�
Electrical /jT hl- xe gtZ4711L. /
Sub- Mailing Address - Conta rson Nam Phone#
Contractor d -
boy -1� E l� ' gr
City/State Zip Pho
Prior to permit 'J i
issuance,a copy v� a�AE'iH � yti 3 S '� FOR OFFICE USE ONLY: _
of all licenses are Oregon Const Cont Board Exp Date Plat#: M !T LJ--
required if Lic,0
expired in COT
database Electrical Lic If Exp Date Setbacks: Zone: n
34 -432 c- - ---
Electrical Supervisor Lic q Exp Date Engineering roval Planning Approval: TIF:
IUA4- (+Z � L Cro -
3
6A 7,-z.+t L - '3�V
y '7Q2 i Wats\formslsfa-new doc 11/2019e
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CITY OF TI�G/4RD credit No.:
Date Issued. _ Ju�n _2
Engineering
Authorization
Date:
w
TRAFFIC IMPACT FEE
CREDIT VOUCHER Land Use
Casefile No.: $7-5.17 P_D1S/DLIA
In accordance with Ordinance 379 Cypress Ventures
pyre d OavrcD+d
is entitled to $._Z92,2 .9 in Traffic Impact Fee Credits tt at n bE, applied to TIF
FAVI A&4
charges for development on lot(s) ,�I of the 0uail hlollowv 11UM Developments. To use
this credit, present this form a'1 the time of issuance of the building permit.
a
Date Permit Numbers Lot Numbers Credit Used Balance
Beginning Balance $_ 2254.91
J
Balance carried forward to TIF Credit No. _
• Ordinance 379 provides for an expiration 7 years from authorization.
Use Additional pages if necessary.
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