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11900 SW LINCOLN AVENUE 11900 SW LINCOLN AVENUE 1 G O U C a 3 Lo O O I November 15, 1990 Crj ITY OF TIG ARD OREGON Wayne JLc 11 / 1190Q S.W. Lincoln Street Tigarl, Oregon 97223 Res :11900 S.W. Lincolnotreet Tigard, Oregon 97223 Permit #1 � " PLM 891593 Dear Mr. Jacox, The last inspection conducted on the above project was an iasulation inspection on 4-24-90. The next required :inspection W.11 be for a final and water heater.. Please advise the Buildinq Division of the status of this project as soon as possible so the file may be kept current. Please note Lhat any permit without "7tivity for over. 180 days becomes void. If you nerd ,additional time to complete the project, please --ontact this deppitment so that an extension can be discussed. Sincerely, Brad Roabl. Building OffLcia-- BR/kp Not i.ce.1 13125 SW l-all Blvd.,RO.Box 23397,Tl,,7ard,Oregon 97223 (503)639-4171 iNSPECTION NOTICE City of Tigard Building Depar'ment P.O. Box 23397 Tigard, Oregon 97123 Phone: 639-4175 Type of Inspection t'l a —"t i A.1 3a'Ti o A—j Date Requested_-AL 2`�"`�0 _ Time __A.M. 3',6C P.M. Address I l <T400 w r GfaA A/ _ Permit #_1 Owner_ ___ _ Lot * Builder_ O �0 The follo:rina Building Code deficiencies are required to be corrected: �_��L Wil` �ra��.,�9 ✓,v:,,.:'-� ;�� �: Tre v w L,C.._ Presented to KApproved Inspector _ _�/❑ 'Disapproved Date y CALL FOR REINSPF_MON 0 YES 0 NU INSPECTION NiOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 e; Tyre of Inspection Date Requested - / Time A.M. P.M. 1 Address __���lJ� �C�� �! Permit Owner iz)A::,.___ Lot #__ Builder The following Building Code deficiencies are required to be corrected: r CA c0- AV4Aey �y elez 7—x Presented to Approved Inspector _ ❑ Disapproved Date CALL_ FOR REINSPECTION ❑ YES ❑ NO WW CIT' OF TIFA RIS MECHANICAL F."E R M IT' OREGON COMMUNITY DEVELOPMENT DEPARTMENT CITYOFTWARD�, . . . . . . . .. MEC90 006:1 13126 SW HWI Blvd. P.O.Sm 23397,TOW,Or"m 972M(503)63W 4175 F.If'.1M.. PERMIT #. : MEC-30 01,461. 4111 DAIL 1(_4WFnp ,31 11::. A 1)1)R E S'S. J.:1`0 0 SW I INCOL14 AVE:: F 1 0 R C E L I S 1'3,7,1)C: SUDDIVISION. . . . z()NI 14 G HLOCK. . . . . . . . . . .d LOT'. . . . . . . .. .............. CLASS OF WORF. . .-ADD FLOOR FURN. . . . .. 17VAP COOLERS: TYPE OF' USE. . , ',t" UNIT HEATERS. . : VENT FANS. . . : OCCUPANCY GR !,,.3 VENTE) W/O APDL: VENT SYSTEMS.- STORIES. . . . . . . . .. ROILERS/COMPRLSGORS HOODS. . . . . . . i FUEL HP. DOMES. INCIN: ./WOD/ 3-15 HP. . . . - (.',OMML. INCINs MAX INPUT: HTU 15--30 HP. . .. . :: REPAIR UNITS: 17:1RL DAMPERS .'. . ,:39....`:10 HP. . . . WOODS-T-C)VE-:S.(,.A I GAS F'RESSURE. . . 504- CLO DRYERS. .-:- NO. or UNITS........_..__..__._._.... AIR HANDLING UNITS OTHER UNITS. c TURN ' J.00V BTU: (nn 1.0000 efni: GAS OUTLETS. FURN BIU: > 10000 efnl: Reniarl.l.scc Wintwiatt.)ve ear <aiJc:l Owrier; FEES WAY11F. JACOX type 'A n)C)t.t 11 t by date -reept :11-900 SW LINCOLN PAYM $ 15.23 JLH 03/29/90 F'R MT $ :1.4. 50 'I IGARD R 97 2 2 3 5PCT $ 0. 73 Pharle #9 Cc)rlt-raetov: _ _.._._.._.........._....__..__.__..__. OWNE:R/CONTROC TOR P 11 a 1-)0 $ 1'5. 23 TOTAI Reg #J. RF_-_.01JIRED INSPECTIONS This permit is issued subject to the regulations contained in the FJ.iial Irispest ion Tiji.rd Municipal Code, State of Ore. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 188 days of issuance, or if work is suspendeO for more ...... than id" days. Pe v nvi.t t P e S i.q i-i e t t.t r e- ................................... ISSUed By . ......... Ca1I for 111speetiL)ri 639 41'75 I C I T'r CIF T I GARD RECEIPT OF PA r OU'll REC NO: Out 080'?b CHE0., AMOUNT a 15.23 NAM,-,t WAYNE JACOX CASH AMOU14T a .UO HDDRESias 111?00 3W LINCOLN PAYMENT DATE s 03-29-90 TIGAPLi. OR 97'227' KOCK NU:POURS PIJRPOriE�OF'�PAYMENT r` r` AMOUNT PAID PUPPO5E�O1F F-AfMENT AMOUNT PAID MECHANICAL PERM (90-0061 ! 14.50 STATE BUILD F'ERMT T TAX (5%, I +f I TOTAL AMOUNT PAID I CITY OF TIGARD - RECEIPT OF PAYMENT REC NOt 001077' CHECK: AMOUNT s 1'?R.rj1 I NAME: OHI CCS C©6TRUI-r 1 CIN CA51i AMOUNT r .On FDOPESSs 17"55 S.W. PILKINGTON PD. PAYMENT DATF LAVE OSWEGO. OP: 9707n BLOC.1:' NO/ArPURs 11900 S.W. LINCZLN AVE. PURPO!-�,E OF PAYMENT AMOUNT FAIf? OF PAYMENT AMOUNT PAID i i i BUILDING F'FPMIT (90--0040 11'-.5o C rAlF BUTL-) PERMIT TAX i5l,. `S.H" PLAN CHER FEE 75.7:, J II i THAM -YClU To TAi. AMOUNT PAID - - - -. t aH.06 P� G r:N 5V 7 Z v CITY CSF TIGA RD CITY TIG ARD TIVARD COMMUNITY DEVELOPMENT DEPARTMENT \ OREGON 13125 SW l'+4 Blvd. P.O.Box 23397,Tigard,Oregon 97223(503)639A175 �� CI 'Y OF TIGARD - BUILDING PERMIT PERMIT N. . . . . . . : BUP90-0043 PRIM. PERMIT M. : BUP90-0042 DATE ISSUED: 02/16/90 SITE ADDRESS. . . : 11900 SW LINCOLN AVE PARCEL: 1S135DC-00800 SUBDIVISION. . . . : TIGARDVILLE PARK ZONING: R-12 BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . :8 ------------------------------------------------------------------------------------ ETSSUE: FLOOR AREAS---------- EXTERIOR WALL CONSTRUCTION.- LASS OF WORK. :REP FIRST. . . . : sf N: S: E: W: TYPE OF USE. . . :SF SECOND. . . : of PROTECT OPENINGS?----------- TYPE OF CONST. :5N THIRD. . . . : sf N: S: E: W: OCCUPANCY GRP. :R3 TOTAL------: Bf ROOF CON.1T: FIRE RET?: OCCUPANCY LOAD: BASEMENT. : sf AREA SEP. RATED: STOR. : HT. : ft GARAGE. . . : sf OCCU SEP. RATED: BSMT?: MEZZ?: REQD SETBACKS------ REQUIRED-------------------- FLOOR LOAD. . . . : psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET. . : WELLING UNITS:1 FRNT: ft REAR: ft PIE ALRM: HNDICP ACC: BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: Remarks: BURN OUT REPAIR Owner: ----------------------------------------•------...---------------- ---•------------- "TEES ---------------- REGON HOME IMPROVEMENT CO. type amount by -late recpt :.7255 SW PILKINGTON ?RMT $ 116.50 LAKE OSWEGO PLCK $ 75.73 OR 97034 5PCT $ 5.83 Phone #: 635-6248 PAYM $ 1.98.06 JLH 02./16/90 Contractor: ----------------------------- REGON HOME _T.MPROVEMENT CO INC 17255 SW PILKINGTON RD AKE OSUEGO OR. 97035 -------------------------------------- honF M: 635-6248 $ 198.06 TOTAL ag U . : 34908 i ------- REQUIRED INSPECTIONS -----.-- hie permit is issued subject to the regulations contained in the Framing Insp _ igaz9 Municipal Code, State of Ore. Specialty Codes and all other. Insulati.on Insp applicable laws. All work will be done in accordance with Gyp Board Inop approved plane. This permit will expire if work is not started Gyp Board Insp within 180 days of issuance, or if work i.s suspended for more Final Inspection _ han 180 days. T. - Permittee Signature: —_ Issued By: Call for inspection - 639-4175 fk O� • �1 aCP �.— �z 111M 0 AM re- ,Qct Pyc�-� •'� eelg/acr- c0/�4� �p�tcC Scud rloar Dl. ' e,,a.x i /eellAce of,-.0. 401riA/, �• sip I o i I ---CIIYOFTIFARD urroFncXra PLAN CHECK APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT 0600 P( AN CHECK N 1:112SSw.1W Wrd-VO.Bok 7J31 1igarctOregon grnl.(SM)63941 M �. -- � PERMIT ,--- DOTE ISSUED JOB ADDRESS: /�Uc' TAX MAP/LOT _ SUB: _ LOT: LAND USE: _..__ VALUA f ION:4,L 50 C> OWNER_ SPECIAL NO-'LS NAME: (.ti?Fl YAJ c. _T/iON — REISSUE O.- . -- ADDRESS: 5 Lam' A. LAST REISSUE: FLOOD PLAIN/ _ SENSIIIVE LAND: APPROVALS REQUIRED CONTRACTOR PLANNING: NAME: C,eir (rcej i-tornE" .S MPo�-OvernQrL'% Cy . ENGINEERING: Fc ADDRESS: FIRE DEPT — OTHER: — - PHONE: (c, Z, ��_C ITEMS REQUIRED BUILDERS BOARD N: Z EXP DATE: LIST/SUBCONTRACTORS: BUS TAX: ARCH/ENGINEEP CALCULATIONS: NAME.: _ TRUSL' DETAILS: ADDRE aS — OTHER: PHONE: --�- --- _ - COMMENTS: L/��j,' '—y�g;-�.E�- �.%j��„� ��y,-�.�_�"'LZ'��' y• �-. [.� X.-�— SUBCONTRACTORS: PLUMB: MECH: PLRMII # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE u�yZ 10-432 00 Building (permit Fees 10-431 00 Plumbing Permit Fees _ - _ 10--431 01 Mechanical Permit Fees _ 10-230 01 State Building Tax (5%) _ Sy I Building Plumbing _ Mech _ 10--433 00 Plans Check Fee Building Plumbing Much __—_-- --_ _ 30--202 00 Sewei Connection 30--444 00 Sewer Inspection 51--448 00 Street System Dev r'.harge (SC:.) 52-449 00 Parks System Dei.+ Charge (PD(;) 31-450 00 Storm Drainage :,yst Deg. Chr3 (SSDC) _ 10-230 06 Fire �-� 101AI � ��_ y RLC N APPL ICANI S i GNAT0RL —-—- �- �- -- Received BY: _^ Date Received: cn/3587P/181, INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 1 igard, Oregon 97223 ¢ J/'hone- 639-4175 Type of Inspecticn -7 d t5 Date Requested__ _ Tim —~— fj� � Address Permit #�� Owner / "� �Lot Builder !/ G �'F 4z" �``, 'C' - —� The following Building Code deficiencies are requi4ii to be corrected: Presented to Approved Inspector _ __ _ C_I Disapproved nate CALL FOR REINSPECTION 0 YES Cl NO PLIJIMIEITW', PERMIT i CITY 0FT11FAPJL� ah�61111111 PE111MIT NO . : PI-1391-1593 COMMUNITY DEVELOPMENT DEPARTMENT WHIM 13121 S W r1mll Blvd..P 0 Box 23397.Tigard.Oregon 97223.(503)639A175 DATIii: I:SSLJF.*U4 7/2 61,109 PP IM . PKT .NO . 0 9 V-5 9 JOD ADDAEf-;G : 1.1.900 5W LINCOLN AVE* TAX MAP/L..0 T' 5UD: L.T : I AND USE4 1...1' T NO; NO WUPK CA-Ati!i : ADD IA'SON WA-TEP CAA)SE.'T TPAP USE 'T'Yl'-"I::* : i5ING1..A: FAMIA Y UPINAL BKI;:*I..()W PIAIVISITR CON54' .I'yr)F:.. . I AVOPATUPY '1410-11P NIUME-44 TUB 51-10WE4r TRAPS 1'.1115HWASHER (:;ARHAGPE D1511-105AL NO . 5111RIE5 WASHING MA(::HINE'.' 1:)Wr-.':l L..UNITS : I AUNDPY TPAY BLDG . DPAIN (EYEA FA-0(:1P E)PA:I'.N 5INK WA'T*E:R HEATE.W W FIJK5 : N JACUX PE441111, 11111.3 . 00 E 1.1.900 F4-iW LINCOLN 1AX.-OAPI.) ('.)P 97223 FIXTURE'S C 0*11-111FA 0 N T R 4*('4)1•T*T1 AND HEATIN(l. A C 3102 SW FITTH T 0 P('114TI AND 014 R H 1::.U.1.!:1 1 1-4 n I J.U N Mt.) 3.303 1 11:11TAL : $114!5 . This permit is issued subject to the regulations contained In Title 14 of the TIVIC, State of Oregon Specialty Codes,coning regulations P EKC,k--T P'T' N c). and all other applicable codes and ordinances. and It is hereby agreed that the work will be done in accordance with the plans and I-4EQJ.13:1 FJ1 :1:N'5PE:c,*r3:(:)N5 specifications and in compliance with all applicable codes and FINAL ordinances The Issuenre of this permit does not waive restrictive covenants Contractor and subcontractors shall have current city business tax permits. This permit will expire and become null and void if work is not started within 180 days,or!f work is suspended or abandoned for a period of 180 days any t to after work has commenced. It shall be the responsibility of the permittee to assure all required insrec s are reque ted and approved. Permittee Signature Issued By: HER SEPARATE PERMITS REOUIPED W6W&"'f4d-'6tS-1b(1bED ABOVE ME C,HANICAL PE C4M:I:'I' NO. : OES91592 C1� OFT11FARD cnyr4i�61111) DA'T*E' ISSUEO: COMMUNITY DEVELOPMENT DEPARTMENT ppIM . rAm'r .NO . 891592 13125 S.W.Hali Blvd.,P.O.Box 23397,T'gard.Oregon 91223,(503)6394175 JOE) ADE)PESS : 1.1900 SW I INCOLN AVI;'-' I'AX MAP/L.01, SUR SK I-AND USE : NO: N('.) WORK CLASS : ADDIA '10N I:;'UPNACF.;*. (J.00K 1. A11:4 HANDI 1:4 <1.0 t IS 'AMI L + 1--IANUI-.P 10K .E J'YPE: SING'sl-E.: 1:� -Y 1:1.114NACE J.00K AIR (:',(:)NS*I' . FL OUP F:*t.JPNA(."'E: E-':VAI'-) .COOLER ("XICUP . Glip. VENT FAN VENT F.A..14/cOMP, HOOD NO . r : DI 1:1/(::cIMP :3 1-15HP INCINE.:PAI(JR 11DOM 1'. 3 'INEKPATOP(CUM .�l Iia'.OMP I.,"i , 0HP INC IDWELL. .UNIT'i ; 14/(*,(:)Ml:) 30-t-50HP Pkii-PAIR UNII'S I'YPE. O'T+IEA MAX .-INPUT 01 A/CUMP-1 10+11r) (3A5 PIP"ING OU'll EA'S [PE'. DMPI451? .: : 1-4 1 GH PRE5$'-I I-OW PV1:.:SS7 PE.MARKS : Fr-'Es : JA COX PERMIT !h 1.0 .00 0 .. W J.:1.900 SW I INC('A.-N PLAN 14EKV1.EIW N G A 1:4 D OR 97122*�5 F 3:X T U VIE.S !I+1.0 . 00 E S"I'A"I'E. l'AX IV 1. . 0 0 R OTHER C 0 PORTI AND HEAIIN(� N T 3102 SW R POP"I'LAND 011 A C TOTAI 11112�1- 00 T NO. 1.303 0 RI 7 W AECE.T.P r N 0. This permit is issued subject to the regulations contained In Title 14 IiIL'.*.QtJ:IJ*KD INSPECTIONS of the TMC. State of Oregon Specialty Codes, zoning regulations and all other applicable codes and ordinances. and It Is hereby agreed that the work will be done in accordance with the plarif.and POST & BE-AM specifications and in compliance with all applicable codes and IN ordinances The issuanc3 of this permit does not waive restrictive 1:7 TNAI covenants Contractor and subcontractors shall have current city business tax permits. This permit will expire and become null and void it work Is not started within 180 days,or if work IS Suspended or abandoned for a period of 180 days any time after work has commenced.It shall the responsibility of the permittee to assure all required inspec s;;epe uested and approved. Permittee Signs ore IN%V*'.(.`,'T'TON 639- 11 Issued By SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE t r ity of Tigard 13125 SW Hall Blvd. MECHANICAL PERMIT RePermit rmd d P.O. Box 23397 N — Tigard, OR 97223 Deacdption 539-4175 Table 3A Mechar%Vsl Code QTY PRICE AMT —�- 1) Permit Fee -0- -0- 10.00 Name a Development 2) Supplemental Permit 3.00 .lob AerressFurnace to 1 t/0,000 BTU Address /C0 U ,,�, jj 14 1) incl.ducts&vents / 6.00 Tax I.nt 'map No. 2) Furnace 100,000 BTU f 7.50 incl-duds&vents Lot Block Subeivisfon - Name(«name of bunkum) ) - 3 Floor Furnace incl.vent 6.00 „g Address 4) heater,well heater Owner 4) ^r floor mpunted heater 6'00 CAY/state ZIP - 5 Vent not incl-in appliance permit 3.00 Name ---� -- Repair of heating,refr g., 6) cooling,absorption unit a r10 Addrems pts- Boiler or comp to 3 HP absorp.;mit to 100,000 BTU 6.00 Occupant Citylstate zip 8 Boiler or comp to3HP-15 HP absorp.unit to 500,000 BTU 11'00 9) Boiler or comp 15-30 HP absorp.unit 1h-1 million 15'00 Melling Address --� PhoneBoiler or comp to 30-50 HP '7 10) absorp.unit 1-1.75 million 2-2.50 Gonlractn, cam,/State Boiler or comp to 50 HP zip 11 -? ) absorp.unit 1,750,000 BTU 31'50 safe ;s+r* „�o_ city®,t,.Tu No. Air handling unit to 12) 10,000 CFM 4.50 1 hi"by artmiOdie that I have read Otis app� mft at itrormatkxr given Is 13) Air handling unit ck7.50 ecxnl&.1,that I am mowner« e autlarized agent of the owner,that p4ma sub10,000 CFM imitted are in - -- ---- — com(*&nce with Stare laws.that I am registered with the!'late Buhler)'Hoard.that thet 4 Non portable —� nunber g^'en is correct (n exempt bum State registration please give roarson bekrv). ) evaporate cooler 4.50 Vent fan connected-- �- 15 to a_single duct 3-00 - - - - ---e-- -- ---- Ventilation system not -- ---- ------- 1C� included in appliance permit - 4.50 Hood served by ] 17) mechanical exhaust 4-50 ( Of sgertl) Date Domestic type - --- - -- — Describe work ❑ addition ❑ alterations repair ❑ 18) incinerator W-- --_r- 7.50 to be done residential non-residential O Commercial or industrial - -- ---- 19) tincinr.lator 30.00 type Existing use of __ ------,__� _-----.- _-_ _ building or property Other i.e.,woodslove,water Proposed use of - 20) heater,solar,clothes dryers,etc.- 4.50 building car property _. - 21) Gas piping one to four outlets 2. 2.00 r Type of fuel- oil ❑ natural gas W� LPG ❑ electric. CJ -- 22) More than 4-per oullet NOTICE — _----- --- - -- - SOB-TOTAL IIIIS PERMIT BECOMES NULL AND VOID IF WORK OR CON- -- - --- STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 -_ 5% SURCHARGE DAYS, Oft IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SU8-TOTAL ABANDONED FOR A PERIOD OF 1130 DAYS AT ANY TIME AFTER - — -- WORK IS COMMENCED TOTAL r.Qv Special Conditions i Address._.J�__���t� ��_�lY�-����- Pe>•mit No. _ Name of Occupant Permit charge 1,</ -t t a. fy :-Lt 2 c_ i " c — ®enaectirnrfee Paid by Date connected Type of Building �, � __ Inspection fee-- Service ee —Service Rate � �i Date ' __�_____._— Paid by - Contractor __—____ Assessment__ =� � `� � (o`J Paid Size of connection i CITY OF TIGARD ITUM M N( i 1)1"'R M IT 13125 SW FALL BLVD. P. O. BOX 23397 Applicants must hold Oregon Registration to conduct a plumbing TI GARD, OR 97223 business or must be property owner/cperator not hiring outside help. Name of Develot,-ret — (503}639—�175 C.�, 2 fPlumbing Per mil No. Address G Description Job z=J' i ` ORS 814-21.610 DUAN. PRICE AMT. Tax Lot Map.No. Address FACTURES W Block Subdivision ---- Sink 7.50 _ Name or name of business) Lavalay_-^_— --- _— 7.50 --- iid 7u Tub or Tub/Show"Comb. - i 7.50 Mailing inp rest ---i— Shower Only __----- --- ---7-50 Water Closet 7.50 Owner CitytState Tp ---_-- — -- Dishwasher 7.50 ---- Phone Garbage Disposal --- _ 7.50 -_- - Name -- --- - Washing Machine -- - -- 7.50 Floor Drain 7.50 1Ta7Mr-gAd Fress F. — Water Heater -^-- - ----_ 7.50 - - Occupant CitylSlaie -- Zip taurxfryRoomTray---- - - 7.50 Urinal 7.50 ame �fxxie Other Fixtures(Specify) -- -- 7.50 -----� � 7.50 1rTa7mr� -- FYsor�e--- -- --- 7.50 Contractor City/State -- VZ7p ------ - - 7.50 MISCELLANEOUS -- City Bus Tax No Sew„r 1 sl I00' 3000 tete s -rc o. tete s Buses-Ni Seww-ea.Addit100 -- 15.00 -- - (Resrclential) Water Service 1st 100' 20 DO I hereby acknowledge that I have read this applkatlon.ttut the information Water Ser Am ea.Additt r 15_00 - given is caned.that 1 am rooslered with the State BuikWs E3oand,and also Storm b Rain Drain 1 st.100' 30.00 have a State Plumbing license that the nunt rs giver ,ra axTerl.that all — -- -- plumbing work wail be done in arourdance with applicable provisions of Ore. Storm 6 P.-in Drain Addd.1100 -. -- -15.00 gon Revised Statutes Chapters 447 and 693 and applicable codes and that Mobile Mane Space 25.00 no holp will be off"oysxl txtless iloensed ursder ORS 683 (11 exempt from ---- -._.-_-- - -------- -- - State registration.please give reason below). Back Flow Prevention HOMEOWNERS-I hereby owtify that I am the owner of the property de- Device or Mti F'ollulion Dewe 7.50 scrt)od above,at watch locators I pm*ose to nuke a pl jn* g inetaAetion for Any Trap or Wash Not my own use end Lib property is not bekq constructed for sale,lease or rent Corxtec.'fed b a Rxture----- - - 7.50 ."Basin 7.50 ktsp.of Exist.Piur>t*y 40.00 Per Hr. -- 40.00 Per Hr. Aber of Pkxnbkq wflhln an Exfethsp q1d9 15.00 min. "? AUTNORtZkn SIGNATURE Y ----- --- Date New Bldg.or Build.AddMori 25.00 min. Lcain,sir�r le faniil Describe wrxk now addition(I alwatio t U repair(1 dwe;l 15.00 tq be cfxla residential -- non-residential Ext"ng use o1 lxSUB-TOTAL 1� ltarlq or - - - __ -,-- ------- _ __-- __ u- kae oQ0u"of 5% SURCHARGE hu or Pro Wty ---- ----EW� NI NOT" This pecrrtll becomes null and gold M wc:Ac or oonsouoMon audirmtsod is not rtYn TOTAL --rd wklik 150<feyr,er a rxtr,�nxitm a wort ds arxrperxlaA a abandxx►cl 1n a pvirx:of 19n dells of any ame Ow w[xic Is orxrxwenrxw1 8MC1At. IX3010fTlOftil-- - ----__ _-- --- ---- ._- - -- - Date Issued ___ _-_--- by ---