9596 SW SATTLER STREET i
s
7
-- 9596 SW Sattler St
w w wwjtw
xw
CERTIFIC-AFE OF
OCCUPANCY
CIT(OFTIFARD cn ARD
COMMUNrTY DEVELOPMENT DEPARTMENT cX11100" PERM'.T #. • . . . . . : MST-90 -Q.13:31
13126 SW HjWl BW, P.O.Box 23397,TlpM,OrG9Dn 9?229 ISM)09-4175
31TE ADDRESS. . . 1 9596 SW GAT,rLER ST R- 7 pD
3UBD I V Icj I ON. - - - : I-AII%
ESIDE PLME NG s
BLOCK. . . . . . . . . . I LAT.. . . . . . . . . . . . . . J
A-SS OF WORIJ, :NEW
TYPE OF USE. . . .-SF
OCCUPANCY CARP. cR3
OCCUPANCY 4
TCNANT NAME.
Remarks
Owners
MEL.VIN WAYMIRE
1084'-5 SW DOVER CT
TI,GARD OR 97,;-Z'24
r-,halle #: ',5036396742
MEA-VIN WAYMIRK.
PO BOX 2-31164
T10FIRD OR 97283
Phone #2 6:39 -6742
Reg e. . a 359'76
Occcipamy of the AbOVP Y'OfPv-Priced building i9k hPy-ebY given, and cer-tifies
th'a cumpliAnc-0 with theStAt;e Of Oregon '.ipecialty Corte. fOv- "'10 grol'API
oc:c:uj:,jncy, and uv;v wicler whirh the referenC.-ed Per-mit was 1,765upd,
FIRE DEPARTMENT BUILDING INSPECTOR
POST IN cni%iSPIcl-jOIJS PLACE
IYISPECPICN NOTICE
1 City of Tigard Building DePartfcc•nt
13125 SW HAI' Bled_ Tigard, Or-gon 97223
ip
Inerection Line (RRC•-O-P .one)s 639-'4175 Business Phonef, 9 171
Inepec:tion
:._�_�— --
pouting Plbg. Underelab Mech. Rough-in
Appr/Sdwlk
Gas Line FINALS
pound. Plbg. Top Out
poet/Beam St:ruct.. San. Sewer
Framing -Bldg.'
Plumb.
Post/Beam Mech. Rain Drain Insulation
Plbq. Underfloor water Line Gyp' Bd.
-Hach.
a-1 2� T ime s Am PH
Date RRQURetRdt
Permit
Address: ` .,l
Ru i lder
THE FOLLOWING CORRE ONS ARS Rl`QUIREDs
Date:
lnlpeotorf —
APPROVED DISAPPROVED ___ APPROVED SUBJECT TO ABOVE
Call For Reinap.
r
NNSPECIZON LIOTICF
City of Tigard Building Department
13125 SN Ball Blvd. Tigard, Oregon 9722.3
Inspection Line (Rec-O--Phone)s 639-4175 Business Phone: 639-4171
Inspections__. — —"T"-""'
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Mg. Top Out Gas Line FINALS
Poet/Beam struct. San. Sewer Framing -Bldg.
Po&/Ream Hoch. Rain Drain Insulation -Plumb.
P11YI. underfloor Rater Line Gyp. Bd. -Meeh.
Dete Requested. Times _ /),AM/1 PM
Address: e5-�W f QA� Permit It
Builder: --
THE FOLLORINO OORRE ONS ARE REQUIRED:
_t�
47
Inspectors __A�� _... Dates
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
�,I�QPgCTIOM NOTICE
City of Tigard Building Oepartment
13125 M Ball Blvd. Tigard, Oregon 97223
inspection Line (Roc-O-Ppbne): 639-4175 Business Phone-, 639 71
I
Inspections
Footing P . .
Underelab Mech. Rough-in Appr/Sdwi;
Found. ►q. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg
Post/Beam Mach. Rain Drain lnsu?.ation -P1umL.
Plbg. Underfloor Water Line Gyp. Bd. -Meeh.
Date Requeateds -�� __ Time: __,l,___AM —PM
� z
Address: ��1� � "`�( s Permit --
- ACT
Builder. �� ! T�/ • 1 --------.--
TILE FOLLOWING CORR-F&f7017S ARA REQUIRM
N
Inspectors _---� Dates 2, C
ROVED DISAPPROVED APPROVED SUBJECT TO ASM
Call For Relnap.
i
i
INSPECTION NOTICE
City of Tigard Building Department.
13125 an Sall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phones 639-4175 Business Phon4t 89-4171
Inspection.-__
Footing Plbq. Unearelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out. Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Poet/Ream Mech. Rain Drain (::Insulation -Plumb.
Plbg. Underfloor water Line Gyp. Bd. -Meeh. /J
Date Requesteds 'd `TTimes AM
Address: Permit Is�'
3
Builders_ 2"A4&1
THE FOIJAY4THO CORRF,CTIAS ARE REQUIREDr
i 1
inspectors natel--
ROVED DISAPPROVED APPROVED SUBJRCT TO ABOVE
__Call For Reinsp.
t WIN ! Slf
INSPECTION NOT_g
City of Tigard Building Department-
1312S SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phones 639-4175 Business Phone: 639-4171
Inspections —— ——
Footing Mg. Underelab Much. Rough-in Appr/Sdwlk
Pound. P1 Tobg p Out Gas Line FINAL:
Post/Beam struct. San. Sewer Framing ) -Bldg.
Post/Beam Mach. Rain Drain Inaulet on -Plumb.
Pl.bq. Underfloor Water Line Gyp. Bd. -Mech.
Uate Requestedt _ Timet /�'^ ,AM/ PM
Address: rmit 1t11J `� 3 7�
Builders. 4
�LLAZ
THE FOLLONINO CORRE OB8 ARE REQUIRED:
Inspector: -- Date:—
PROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
jNSPECTION NOTICE
City of Tigard Building Departaaent
13125 SW Hall Blvd.. Tigard, Oregon 9722)
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inepection: — —
i
Footing Plbg. Underel.ab (c�Hoch. Rough-in Appr/Sdwlk
Found. Pibq. Top Out OasLino FINAL:
Poet/Beam Struct.. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Draln Insulation -Plumb.
Plbg. Underfloor water Lino Gyp. Bd. -Mech.
- L T11N PM
Date Requeekedt ! Lmes
Address. Permit 1t17
�[/
Builders
THE FOLLOWING CORRECTIONB ARE RfgQTRED:
inalx+ctnr: _ ------, Dat ri�..��'��,�
Y_APPROVED DISAPPROVED -_, APPROVE) SUBJECT TO ABOVE
Call For Reinsp.
t W W R W
INSPECTION NOTICE
City of Tigard Building Departoent
13125 SO Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone% 639-4171
Inspection: --- -- ---- ----- —�
Footing Plbg. Underalab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mach. Rain Drain Insulation -Plumb.
bq. Onderfloof,_�) Water Lina Gyp. Bd. -Meeh.
Data Requented% �� % - �� Time: _AM _.-.__PM
A idresa% Permit f:_
Builder%�____,_,��/1�
THE FOLLOWING cORRECTIOM ARE REQUIRED%
Inspector: __ -- ---__----.-- — Date r_J�P_ -�- —
PROVED _ DISAPPROVED _ APPROVED SUBJE:T TO ABOVE
Call For Reinep.
INmBC71ON NOTICE /
City of Tigard Building Department ��
13125 S11 Ball Blvd. Tigard, Oregon 97223
inspection Line (Rec-O-Phone): 639-4175 Businens P` a 639-4171
Footing Plbg. Uaderalab Mech. Rough-in Appr/Sdwlk
Pound, Plbg. Top Out Cas Line FINAL:
u-
San. Sewer Framing -Bldg.
�pet�8ea■ 8tr
Bt�N� app. Rain Drain Insulation -Plumb.
Plbg. underfloor Nater Lina Gyp. ad. -Koch.
Date Requented: -� �_ Tf.mes 11M PH
Addreen: C —� T Permit 1:T'� - G 3
Builder:_ 1 1
THE FOLLOWING CORRRq"ONS ARE REQUIRED:
Inspector: __-_ — --- —T�� Data:
APPROVED DLSAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinnn.
INSPEcriON
City of Tigard Building Department
13125 SK Ball Blvd. Tigard. Oregon 97223
Inspection Line (Rec•-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:__—_
Footing Plby. Underslab Mach. Rough-in Appr/Sdwlk
Pound. Plbq. Top Out Gas Line FINAL:
Pont/Beam Struct. 8Sewer Framing -Bldg.
Poet/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Sd. -Hoch.
pate Requesteds Z/ Times ___k _AN PN
Address: 1 �1-. --_-_-- Permit `s,�D
THE FOLLOWING CORRECTIONS ARE REQUIRED:
i
2,
Inspector: `/ ' _ Datetg-1
_____APPROVED - DISAPPROVED —i APPROVED SUBJECT TO ABOVE
Call For Reinap.
i
INuPECTION NOTICE
City of Tigard Building DepartmenttPho639-41 13125 SW Ball Blvd. Tigard, Oregon 97
Inspection Liae (RRC-o-Phone): 639-4175 Business
Inspection:
c
Footing Plhg. Underslab Mach. Rough-in Appc/Bdwlk
Found. Plbg. Top Out Gas Line FINALt
Prot/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line `� Gyp. Bd. -Mech. ' f
Date Requested% Z� Q�(1 --------Time: _ 1 AiI �PH
idrose• /•J �(� �L�L Lr- _ Permit f s `�/l —L'���✓
Builder•
THE POLLOWING CORRECTIONS ARE REQUIRED:
--------------
'7 7 1
Inspector: nate:
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
�^l _V—Call For Reinap.
F
CiTyOFTIFARD C17YOFTWARD ::1ILRITII'Tit. IIISV9044331
COMMUN" DEVELOPMENT DEPARTMENT OREGON
13125 SW Heil Blvd. P0.Box 23397,Tigard,C*egon 97223(603)&19-4175 D 1::, TS Si U 1%1) .I. .L J (, P)
5 1. TL A D 1)R EIG S 9r:;`:36 '.3W S A*T T L E R Si
LAK'E'SIDE. PLOCE.
BI L01 . . . . . . . . . . . . ..
...... ....... BUII.DING
R E.1:S S 1.)I:K: DWF''I.-LINC3 U'H1*I ,,'.?-,- 1 BASE hiEN T. . . . . . .. .� -O
CLASS L)I**-' WORK. :NEW BEDRMS:3 E(ATHS:,3 GARAGE. . . . . . . . . . p355 S f
'T Y P F. C.)F U SE::. SI: FLOOR AREAS REOUIRI-
Y'YPE OF' COHS'T. 5N FIRS'T'. 939 f LEF'r. . : io ft R1:G1-11'. e5 'ft
OCCUPnN(:"Y URI' . -R13 SECOND. 858 f 1: RON'T., 120 -f t RlOR. - 99 ft
!'31*0RIES. -.2
THIRD. . . . f REQUIRED-
H 1:*:1'.0 H'1'. -.20 ft 'TO TA I......... ..........--.- 17917 sf 13)IyI 0 11,E. D E C,T 0 R G.. n Y
0 1)R L 0 A 1)- .40 PSf VALUE:.. . . „ » $-1 8905F PARKING SPACES. .. :0
R e nia r k 9;:
................. PLUMBING
S110S. . . .. " . " n :1. FAANJR DR( .HIS. . . . alb PREVKTRS. 0
L A V 01`[)R11 ES WATE".F: HEATERS. - - 21 'T R A PS. . . . . . . . . . . . . . ..0
'TUIVSHOIALRS. » » » -.2 1 A U N 1)R Y TRAYS„ . CATCH POSINS., - - - - -
WATER CLOSETS., 3 S5EWIIR LINE (ft) . 0 GREOSF 'TRAPS. . . . . . . a 0
l)J'SHW0SHr::'.RS. WO'U.':R LINE (ft) . 1.00 0 11-1 E[-� F]XIIJ R E:S)) 0
GORPAGE DISP., t RAIN DR(-)IN (ft) P1
W0SHTI%K3 MACIA. 1. !3F, RAIN DRAT1,15.
.......... III E CJ I A NJ.C,A L FEES
-it
FUEL ... ............ UNIT ::0 tyr)e iiik n)(:)('k I ID y date r P e p
/G Al VEFP 0 P A y 11 T 100. 00 JLH 10/18/90 205987
M A X I Iq I.1 IYT r.0 1?1 U VFINI I P PR,1' a 403. 00
< 1116K .. . - :I HOODS 1 HPLC: (.'-1 1. 9 IIJ
U R F1 )!:r 1,000 (%1 W 0()1)51 0 F P 5P C 20. 1.5
FL 0 0 R F U R 1--1 - 90 CLU DRYL"N5. S'l,1)C 600. 00
pou,-/cmr:, < 0 T IA r-.'R U 114 1 1 S 0 SSDC 375. 00
GAS OUTLE'TS: I V'A R K 250. 00
0 W 1.1 err 39. (8 0
MFI VIN W(I Y M I R E 11 PL C., $
.1.0 8 4 SW 1)C)V F R C-T 115 P $ 1.95
P P R 4, .1.4 7. 50
T'1.G F)R 1) 0 P� 97l'24 1---,5 11 C i, 7. 38
Pl-it)ite fin 5036396742 POYM 201-5. 68 JL.I-I 11/16/90
C c)1-1 t ri.-1 f:. I-,c.)-v t ....................................
MELVIN WAYMIRE
1.0845 SW DOVER CT
T" C'-;ORD IJR 97224
fir. ',:5036396742
0. . 9 35976
PI 15. C,8 10T01..
This permit is issued subject to the regulations contained in the REQUIRED INSPECTIONS
Tinilrd Municipal Code. State of Ore. Specialty Codes and all other F C)c)t f c)I..t I'l d T 11 s:P Meehaiiieal Iiisp
applicable laws. All wort- will be done in accordance with approved Wt,r Proo f i rig ]Hsm Plt.imb 'TOP OU-t
plans. This permit will expire if work is not St rtlpd within 180 Post./Ppani C.)t-vi.tenli
t Fraj.rip Jyi ,,
! p
T,
days of issuance, or if work is susoenod fol mo than ly days. rlt)sf/Peani Mer.+aii F replace Irisp
C-rawl Drai,ii Gass I.J.1le 1.1-)S r)
F,c•,r 111.1, t t.r.,c-, SH.1.4 11 A t 1:11pI ri s t.t 3.a t i c n T.il r-j ri
... .. ......
P L 11/U vi d e-r f I a ci-f- Gyp Bc).%-rd Disr.)
V i;;i;t.i e d H y!i Ftrlp D-rai.1-1 El'sn), t Raj.1-1 d-rair) 11-ISI:)
Call fc).(, 6139-4175
W or
SEWL-R CON1,4EC-11ON
CITYOFTIFARD V,1:::R 111. 1
A
07YOFTWARD� S W 1*-,9 0 0 3 8'.)
rr� 1::,E-R M.1
COMMUN;TY DEVELOPMENT DEPARTMENT oaEaon
13126 SW HWI Blvd. P.O.Box 23397,Tgaid,Oregon 97223(503)639-4175
I-1,:* .1, 15 U E1) 11./1. 9 0
1:-G S 95 9 Fj '61 S A I T L L R E;1' PORCEL: 213111CO-LSP
SUBDIVISION„ .. .. I (I K 1*.-9 1. P L()C E ZONING.-
BLOCK. . . . . .. . . . . U . . . . . . . . . . . . .
Lffln NCI. . . ,, . . . . . ::43119 Fl:X I'U R 1. UNYTG .
OF 1)W L L I...1 N G U H UG) 1.
T'Y P E OF U(3 E. -SF 1,10. OF PIUTLDING' - :L
].'W"iWALL. J'Yf:'E.. DUSWR T.111--'ERV SURFACE". f
R e niA-r,k
C)w ri e-r FEES
1%::L.VTlq WOY111RE type iA M(:)I.t v)t b.Y d a t -r,e c.,P t
10841:��; f:")W MWER CT PR111* $ 1500. 00
TW;P $ 35. 00
11W)RD OR 97PT4 P()Y 11 $ J.535.00 JLH 1.1/16/90
Pl-ic)iie #z 503C,396742
C,o ii t r a c.,t c)-(.. ........................................-- ..........
C'ONT'RA(J0R NCYT' UN FILE
.............
1.535. 00 TOI'AL
RF CIUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewe-r Trispertiari
of the Unified Sewage Agency. The oprait exoires 128 days frog ....................... ...... ...... .........
the date issued. The total amount paid will be forfeited if the
permit expires. The Agency does not quarantee the accuracy of the
side sewer laterals. If the ,,eller is not located at the measurement
given, the installer shall prospect 3 feet in all directions from ........... .. ......... .......
the distance given. If not so located, the install r shall purchase
A "Tap and Side Sewer" Permit and the ftv.n.-, wJ1 )stall a lateral.
Po-rrnitt.-ee
................................
............... ..................
Byr
.. ... .......... .................... ............. ........... ..........
C.All. fc)-r iiis;riecati()i-i 639-41.75
CITY OF TIGARD K"'CEIPT OF F."AYMENT RE-CEIPT 140. qCi--'2()6904
CHECK AMOUNT t 550.60
NAME WAYMIRE. MEL CASH PMOUNT v 0.04)
ADDRESS F`AYMENT DATE 0 ll./ 16/9(-)
SUBDIVISION
9506 SW SATTLER
PURPOSE OF' PAYMENT ArlouNT rAiu 1"ORPOSE OF PAYMENT PMOUNT r-,AiD
PERM 40)."3.00 fl.UMBING F-..,I'---RM 147.`.`0
MECHANICAL PE 39.iif.., ST. BUT.LD PER 2q. 4 El
Pl.AN CHECK FE 171 . 70 SEWER USA 50o.oO
'7)F.V'ER INSPECT
SI)c STORM DRAIN SDC 375.00
jf� lj'iL AMOUNT PAID
'-'"I TY OF:' I T GARD RECICIPT OF PAYMENT RECEIPr NO. 90—2059187
CHECK AMOUNT a 100"(X)
NAME s WAYMIRE=, MEL, (IIASH APIOUN"f e 0. 00
ADDRESS s PAYMENT DATE s 10/ 10/90
OU14D I V.1 S I ON
9596 30) SATTLER
II
P014,09E. UP P ,ME'Nl- AMOLIN'T PA F D PURPOSE DV' PA'y"NENT AMOUNT PAID
PLAN CHECK ri R
1 ,171"AL, AMOUNT PATT) 1.(W). (I()
W w► w srr W, W
CITY OF TWA RD �urrs 30 a 23 397 t" 7 PINCK/RSCr #
y, I'.O.sp -
rpord Oregon 9M3 PST
639
COMMUNITY DEVELOPMENT DEPARTMENT r�'� ISM) -4171
DATE I�SUFA _—
V
JOB ADDRESS: ��'I/ �' C ! /f _ TAX MAP/UV
lB: IAT: — _ 1AND [ISE: _
VALU nON: —--
OWNER SPECIAL. NOTES
NAME: - Rff S UE OF:
AD(lEJESS: LAST Rms,-m: _
-- _ FOOD Pf IN/
-- -- SENSrIl.VE IAM:
PE10NE: — —
_ AfPRf7VAI,. ILDQUII2ED
C7ONMCrOR PLANNIM: --
NAME: -- — _ EIIGINE ERIlJ .-
ADOPES.S: _ FIRE: DE.Pr
BUYERS DOAM if: EXP DATE: LL4T/ -
BU3 TAX: —
AR0j/EW,1NEER CA1ACLUWff0NS=
NAME: _ _ — TRUSS DETAILS:
ADS: --
PHONE: ___ .----- _----
i5:
P7J3 I8: MDCH: — --_ --
PERMrr f AOCT if DESCRIMCN AMOWr AMMW PD_ BAL. DUE
10-,432 00 Building Permit Fees
10-431 00 Plumbing Permit Fb--s
10-,431 Ol Mechanical Permit Fees
10-?_30 Ol Statcy Building Tax (5%) ;"
Building —
Plumbing
10-,433 00 Plans Check Fee -- �
Building
Plumbing
Med, --
' 30-202 00 Sewer Omulertlon
fir'• 30-444 00 Sewer DrTecticn
51.--448 00 Street System Dev QUA
52-449 00 rags System Dev Charge (PDC) GJ.
31450 00 Storm Drainage Syst Dev 0" (SSIc')
10-230 06 Fire
1UT1L
APPI.TcANr SICmZURE
Reop_.i.ved By: __--- _ Date Received:
of/3587P.WPF
® PLAN CHECK APPLICATION
CITYOFTIGrARD unOFncalDCHECK /
COMMUNfTY DEVELOPMENT DEPARTMENT OREGON FLAN
13125SWHWWidP.O.Box 23397.TlgW,Oregon 07223(6W)&04176 PERMIT
DATE ISSUED
.JOB ADDRES : _c �r TAX MAP/LOT $/• //CA
SUB: a- c 'e LOT:_ LAND USE:
VALUATION:_ " -- SETBACKS: FRONT: REAR: LEFT: RIGHT:
WORK CLASS: HEIGHT: .CZ ' TOTAL. AREA: 17 '? 7
USE TYPE: _ FLOOR LOAD: 1ST: 2,39
CONSTR TYPE: HEAT TYPE: 'ea s 2ND: �S X
OCCUP GROUP: DWELL/UNITS:, 3RD:
OCCUP LOAD: NO BEDROOMS: 3 BASEMENT: _
NO STORIES: NO BATHS: .1 GARAGE* n "
IMP SURFACE:
APPROVALS REQ'D SPECIAL NOTES ITEMS REQUIRED
PLANNING: REISSUE OF: LIST SUBCONTRACTORS:
ENGINEERING: LAST REISSUE:_ BUS TAX:
FIRE DEPT.: FLOOD PLAIN/ CALCULATIONS:
OTHER: SEN LND.: _ TRUSS DETAILS: _
PARKING PLAN:
LANDSCAPE PLAN:
PLAN CHECK BY: OTHER:
COMMENTS:
ACCT DESCRIPTIONi AM
WNT
OWNER 10-432 Building Permit Feesyy3I(A(L,_
NAME: _ 10-431-600 Plumbing Permit Fees _51)
ADDRESS: 10-431-601 Mechanical Permit Fees 1q cc,
10-230-501 State Building Tax (5%) 4 4,3
10-433 Plana Check Fee i48_
PHONE: 30-443 Sewer Connection (20x) _
1 30-202 Sewer Connection (80x)
CONTRACTOR 3�II� 30-444 Sewer Inspection
NAME: �y'C _ .51-448 Street System Dev. Charge (SDC) lc• U
ADDRESS: chc aZ3//G y 52-449-610 Parks I System Dev. Charge (PDC) 5`4
52-449-620 Parka II System Dev. Charge (PDC) s
_ 31-450 Storm Drainage Syst Dev Chrg(SSDC)
PIIONE: (.; <�-(; `7y 2 10-230-505 TRFD (95x)
10-435 TRFD (5%) �
ARCH/ENGINEER 10-230-506 Washington County Fire #1 (95%)
NAME:) . ,i-�- V /'X r 10-435 Washington County Fire Al (5X)
ADDRSS: ClL.1 1 10-220 Amart/Wedgewood
�, �.�/ M5* 90 0 .33 I@
0 3 � 1 TOTAL t 3do S D,a
PHONE:- C. 4/.5- cj Z 0 ;L _
PREPAID c t'
REC 0
AAPPL
BALANCE DUE J-556),(
..ANTS NAT RE
Received By: Date Received:
w t s w sXF
GRt U G/EROSION (_ ONTROL INI:ORMAI ION
GE R L CO ACTOR NAME&ADDRESS: CASEFILE NO.:
J'•t i» •(' PERMIT NO.: –
v '
APPLICANTNAME AND ADDRESS:
EXCAVATION CONTRACTOR
NAME&ADDRESS_:
OWNER NAME AND ADDRESS:
TELEPHONE E .
APPLICANT , a CC 3�� ;`7`-- PROPERTY DESCRIPTION:
OWNER- C= L,3 y -�, 7 L1.2 STREET ADDRESS AND CROSS STREETILOCATED
GENERAL CONTRACTOR: '!
EXCAVATION CONTRACTOR: i