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11880 SW PACIFIC HIGHWAY REVISIONS BY � +c15Tir.-!C oca. E�A:; E T4 bE Pv . > 171VE DR.Ai Wk rIt.. ;: TO � r., `%�, F�E 1-. M,A X C: F t�.f ` i � �( A A 5 H© T(80 . 5? u, LI ?_ ,�y TIi 11/` L6� tW_ <:A1_. . GF MD}JO - 1)AP. C- H �.U !�• � � GALS p� t� to � .F " r + • t K, -CLJ Ft,S F- ; D b E ' 0 W C T r D T D y-5 "%G R F..L AX DL WS I T``j' AA g H -D -r GE Wm. OTTEN 11 �f'E r01t�` to lye oV , ; ! : • �'c L A\-1- F R 33/'4•, M , ►J G P k 1.5 H E D R©GK., -- { . + ' � --, � np•I ppA D P M. O � � ti� nr 17 r!"' � x . ✓� I t'J � I�i�/ v �'-•. ....©U �� � -`, , c bre. � G�► o P y� �r Gn 1 FAVI NG 1 TA I L. f" s f , - Qu \' 1 • to O Q 0 $ C. C o M f Existf*ng Un,15aved Parking Ailea i T: WIT M I I I 1 �, r'•_`. THE:T1— `G DIRI'C. z 'mj i LIJ r < 0am n ` { + .�.--•------.._ �; � Gee^�S ` > '0 ui GARDEN S _ ----- _ a. IGS r. �+�' r� - _-._- } _ .._..,---'-'._.-•-•----' -- A�'FROVF[� FOR CONSTRUCTION 1 C, a*Ky _ __ Y CITY OF TIGARD SITE ADDRES _�---- — LU Tx __- - ► I C DATE b C __ _._--• TITLE______!-. Q BY a. — No _TH cc 1�e a. Date N Scale I Zo^0 ? I G R. YJ `,N 1�1 1N/'�5 H . GO• Drawn _ - ( .!,6 AG .lob R�55 CNt'v" TO x. �V�Q �~ Sheet 1. 1 B A i S(}.I 1 MJF 1 0o/1,,r���pN,. ' .vl��:�.sw". - .. .. .y/Yyp �,•w.-,,..a.em... - ,•.amu, n•w•.- - —...,_m.»....�...r..... .«... wu.w .--.-,fly« - 1 1 (,� ' 11111 '1 11,1+11 �1,1�i11 111111 1 1111 111111r Illlffl (111 i�'11111 11x1111 111111 1111111 1111x11 1111111 1111111 1111111 1111111 IIII111 1111111 r111r11 1111111 111111111111111 _ 1 ,• '_. . I � I ' �' I II 1 2 3 4 5 6 7 8 9 10 11 12 _ NOTE: 1F THIS MICROFILMED .......... , DRAWING 1S I ESS CLEAR THAN THIS NOTICE;- IT 15 DUE TO THF QUALITY OF THE ORIGINAL a --DRAWING. OE 62 82 /.2 9``2 S2 b2 E2 22 IZ OR 61 BI LI 91 SI bl �EI �tl� II 01 6 9 L 9 2 b � E 2� lallliall INII1111111Ill 11it III Ill 1111I1111IIIIll 1411111111111111111111111tI,1111111111111INllllllllllllllllll11�1111111111111N11111111111Ill!1111111it11W111Ill Ill 1111111ill 11Ill 1111Nill IIill IIill Ill 111U111111�11JIIIu�u111111111111111NIIIIlIll1111WI1111�1111I1l11�IIllIWIIIJIIIIIlIIIIIIIIWIIIrI 11111111 MAY 7 19 92 _ MEN 11880 SW PACIFIC HIGHdAY U '"gT I0f1 NOT I CIC city of Tigard Building Department �. 13125 811 Ball Blvd. Tigard, Oregon 97223 Inspection Line (Rec-G-Phone): 639-$175 Business Phon 639-4171 Inspection:_- �� L �- -6z Footing lilbg. Underalab hloch. Rough-in Appr/Sdwlk Found. Plbg. Top out Gai Line FINAL: Post/Beam Struct. San. Sewer Framing -Bldg. Poet/Beam Hoch. Rain Drain Insulation -Plumb. Plbg. Underfloor Water Line Gyp. Bd. -Hoch. `��J� Date Requested:_ _ — / Tis K. Address: L� Permit #: Builder: THR FOLLOWING CORRECTIONS ARE RRQUIRED: Inspector: _ Date$ APPROVED DISAPPROVED APPROVED Ef7EJgCT TO ADM cell For Reinnp. +I![B !R # EEEI' W EI< 1 EEEEfKim BUILDING PERMIT CITYOFTIFARD (c' rffs 6D—n,1 EF?t+1I T #. . . . . . . : k;L1P91 --0024 COKMUNITY DEVELOPMENT DEPARTMENT ORIOON 13125 SWHWIB". P.O.Box 73397,71pard.Orogon 97223(5o3)M-4175 i)ATE ISSUEDs 01/a3/91 f1ARC(_L-: 2.S101BR-0040 ? ! : l L,I ON. . . . : T I GARD ROAD GARDENS ZONING: C-G . . „ . . . . . . LOT. . . • • • • . . . . . . .45-________._._-_________ "I__O0R�ARE.AS _ _... EXTERIOR WALL CONSTRUCT ION- 1..6155 OF- WORK. :AL.T FIRST. . . . : sf N: S: E'i W: OF UGE. . . .COM SECOND. . . : s f PROTECT vc" OF CONST. :5N THIRD. . . . : sf N: S: L3 W° I..( IIF-'ANC Y GRI='. :Br TOTAL --_- 0 s f ROOF CONST: FIRE RE.T":' II r UPANCY 1_C1AD: BASEMENT. - sf AREA SEF. RATED: HT. : ft GARAGE. . . : sf OCCU SEP. RATED: X11 : ME:Z Z'-': REUID SETBACKS-_-_.,_--- REQUIRED _-.._____.____..._ (J(_l(1 L.OAD. . . . : res,� LE_F'T: ft RGHT: 1 t FIR SPK : SMOK DET. . ')WEL-LING UNITS: FRNT: ft REAR: ft FIR ALRMs HNDICP ACC: 1)RW;: 8ATH5: IMP ',SURFACE:: P'RO CORR: PARKING: 11 .JE. $ : 0 n 4,-ks: Move existing IIGEO" sign ---- f'ootinq inspection _._....._.__ ..._._ « - �C- FEES ! I LHF:JRLIL.ET• type amomnt by date cern',-. -W pACIF1C HWY DAVM +6 15. , .7I H 01/x'3/91 FrRMT $ 15. 00 i i iliARD OP 97223 5PC'_T $ 0. 75 / ! 'hI r7 T•1 P 'N : 1 tl f;I(JN CO BAILEY HILL. RD #17 OR 97402 I n #.- 464--55.110 '1 15. 75 TOTAL. 64374 REQUIRED I NSF'ECT IONS This vermit is isse•d subiect to the regulations contained in the Final InsUecti.on - )oard N-inicival Cade. State of (1•e. Stier alto Codes and all other avplicable laws. All work will be done it accordance with _- -_ �. ----•----------- - - anaroveo vians. This permit will expire i` work is not started --- within 180 days of issuance, or if work is suspended for more ---- than ;80 days. mi.ttwe Si gnatt.1re _..___.�..___._..__ _.__.... ..._..._...__.___.. 1 He d P v Call for insoec.tion 639-4175 l I I wll. nwa. PLNCK/RECT # 110 Box TIGAR ) 3us _ - PERMIT # COMMIINIIl' I)I?VELOPMGNT I)I:I'AKTMENT Tigprd,Oregon972D (503)679-1171 DATE ISSUED JOB ADDRESS: �111Q .G�ld TAX MAP/LOT SUB: _ LOT: LAND USE: VALUATION: OWNER SPECIAL_NOTES NAME: '�� L��C�2o �e _ REISSUE OF: ADDRESS: �/���'>>�'� LAST REISSUE: _ _---�--- FLOOD PLAIN/ PHONE: -------- SENSITIVE LAND: CONTRACTOR APPROVALS_REQUIRED NAME: SIGN _ PLANNING: --ADDRESS: ,02;x, 1 Lt:- 8(L C (�_�_— ENGINEERING: _ ��--- 1u �% q7e_ FIRE DEPT: PHONE: 4 .520 __--- OTHER: __-- CONTR. BOARD #: G'y�Z __- EXP DATE: 23 ITEMS RE JIRED SUBCONTRACTORS: PI UMB: . __.._.____._ L I ST/SUBCONTRACTORS: MECH. ---- ------ - — — BITS 'TAX: - --- -----— ARCH/ENGINEER CALCULATIONS: NAME: __.___--_ _ TRUSS DETAILS: ADDRESS: OTHER: -___-- ___------- PHONE: — PROPOSED BLDG USE: COMMENTS: APPLICANT SIGNATURE Received By: __ _ Date Received: t � ITY OF mT 11� � ui2s sw rr,u rswa. PLhCK/RECT # GPO Box 23397 PERMIT # COMMUNM DI;'VELOI'MEN'I'DEPARTMENT Tigard,Oregon 97223 (503)639-+171 DATE ISSUED JOB ADDRESS: < ' i c TAX MAP/LOT SUB: LOT: LAND USE: _ __— VALUATION: _ OWNER SPECIAL NOTES NAME: 'ud�— �/ �''t'''���` REISSUE OF: ADDRESS: LAST REISSUE: FLOOD PLAIN/ PHONE: SENSITIVE LAND: CONTRACTOR APPROVALS -REQUIRED -- �, ,�(CN _ : NAME: PLANNING: 1125 PArLEy /-{("L FPn � � ENGINEERING: --_ �_— %LiG 174FIRE DEPT:_ —_— PHONE: Q Gi( ' OTHER: _ CONTR. BOARD #: ' / EXP DATE: ITEMS REQUIRED SUBCONTRACTORS: PLUMB: LIST/SUBCONTRACTORS: MECH: BUS FAX: ARCH ENGINE R CALCULATIONS: _— NAME: __ TRUSS DETAILS: ADDRESS: _ OTHER: _ ---_ _---- PHONE: J PROPOSED BLDG. USE: COMMENTS:JLJ —— . —ELLA-TC J1r'Fl_1 CA"T SIGNATURE Received By' _ Date Received: ,/ 3 PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE 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%) Building Plumbing _ Mechanical 10-433 00 Plans Check Fee — Building Plumbing Mechanical 10-230 06 Fire — — ---- 30-202 00 Sewer Connection _ 30-444 00 Sewer Inspection 25-448-02 Commercial (IF Fees 25-448-04 Industrial TIF Fees - 25--448-06 Institutional TIF Fees �-�_-- 25-448-03 Office TIF Fees 25-448-01 Residential Traffic Fees25-448-05 Mass Mass Transit TIF Fees 52-449 00 Parks System Dev Charge (PDC) 31-450 00 Storm Drainage Syst Dev Chrg (SSDC) -_---- 24-445-01 Water Quality (Fee in lieu of) 24-445-02 Water Quantity (Fee in lieu of) TOTAL — — _ A5 — nm/3587P.WPF GROUP SUMMARY 'EDIT PARCEL NAME ACTION CONDITION LOG-NOTE FEE DOC MISC ESC hist other cafes in project: group :Bt1P892478 PRU��ECT:89247r3 STATUS:F UPD:07/31/90: :BCR: . PERMITTEE:RUSS CHEVROLET PRIM. . :892478 ° SITE ADURESS:11880 SW PACIFIC HWY uaDESCRIPTION OF Fotting for frestanding sign REISSUEsBUP FL(K)n. AREAS---------- EXTERIOR WALL CONSTRUCTION . ° CLAS: OF WORK. :NEW: F'{FIST. . . . : :sf N: : S: E: : W: : TYPE OF USE. . . :OTR: SECOND. . . : :Bf PROTECT OPENINGS?--------- . TYPE OF CONST. : . . . . :Bf N: S: E: : W' , OCCUPANCY GRP. : sTOTAi.------: :sf ROOF CONST: : FIRE RET?: . OCCUPANCY LOAD: BASEMENT. : AREA SEP. RATED: STOR. ; : HT. . : 20:ft GARAGE. . . : OCCU SEP. RATED: ° BSMT?: ME27.?: REQD SETBACKS-------- REQUIRED------------------- FLOOR LOAD. . . . : :psf LEFT: :ft RGHT: :ft FIR SPKL: SMOK DET. . : : DWELLING UNITS: FRNT: :ft REAR: :ft FIR ALRM: HNDICP ACC: : AFDRMS: : BATHS: IMP SURFACE: PRO CORR: PARKING: VALU $: 0: NOTES: HISTORY: VIEW UPDATE DELETE ESC View comments for selected item b££££G 6ABUILDING ° ;BUP892478 PROJECT:892478 STATUS:F : UPD:07/31/90: :BCR: e ° PERMITTEE:RUSS CHEVROLET PRIM. . :892478 SITE ADDRESS:11880 SW PAC_IFiC HWY C)£ CASE HISTORY £££££££££££££££££££££££bReq/Sent£Schd/Due£End/Done££By£Stat£SflG ° C706 Foot/Found Inep 02/20/90 BCR PASS " �I � CITY OF TIGORn RECEIPT OF PAYMENT RECrIPIT NO. a91-POW'14 CHECK qMOUNT '5. 7'-j NOME STFIN SIGN GAal PAOUN'r Vii. 00 ADDRESS PnYMENT DATE: a o1/25/91 SUB D I V 1 S I ON 11880 ciW POC I F I C HWY 1-)IARFIOSE OF PAYMENT AMOUNT POI PURPOSE OF PAYMENT r4`jni-INT PAID .............--- r4111...DING PERM SUP91-0024 113. 00 ST. BUILD PER IA. 75 RWIS CHEVROI-Ef I. All0UNV f-`Alt) 15. 75 C17YOFTIFARD HUiLDI. : PERMIT ` PCkMIT NO. : HU892478 C17YOF T16ARD COMMUNITY DEVELOPMENT DEPARTMENT' °a11°°" 1 TE ISSUED: 1116/89 13125SW HaliBlvd.P.O.Box 23397.Tigard.Oregon 97223.(503)639-4175 -'♦• TM.PMT.NO. 892478 JOB ADDRESS: 11880 SW PACIFIC, HWY TAX MAP/LOT 2S11BB SUB: LAND USE: LOT SIZE: VALUATION: SETBACKS FRONT: REAR: WORK CI_ASSi NEW DWELL.UNITS: I_.EF'Ta RIGHT: USE TYPE: OTHER NO.BEDROOMS: FXT.WALL CONST: CONST.TYPE: NO.BATHS: N: S: E: W: OCCUP.GRP. : PROT.OPENINGS: OCCUP.LOAD N: S� E: W: TOTAL AREA: NO.STORIES: 1ST: ROOF CONST: FIRE RET? HEIGHT: 28 2ND: AREA SEPAR? RATED: BASEMENT? 3RDe OCCUP.SEPAR? RATED: MEZZANINE? BASEM'T FLOOR LOAD: GARAGE: FIRE SPRKLP? ALARM? FLOW(GPM) DETECT? HEAT TYPE: HDCP.ACCESS? CORR? PLAN CHECK BY: br.r REMARKS: FoOtinq for frestandinq sign REISSUE OF NO. LAST REISSUE FEES: O W Chevrolet Russ PERMIT $15.80 N 1.18813 SW Pacific Hwy PLAN REVIEW E N Tigard 07. 97223 FIRE DEPT STATE TAX $.75 — — -- -- — —----- OTHER C DEVELOPMENT CHARGES: SDC(STORM) N SDC(STREET) R PDC(M > C PREPAID i ) T R _ ___-- TOTAL: $15. 75 RECEIPT_NO. 1 rus permit is Issued subject to the regulations contained in Title 14 __________.__ of the TMC, State of Oregon Specialty Codes.coning regulations REQUIRED INSPECTIONS _ and all other applicable codes and ordinances, and it is herby agreed that the work will be done in accord- ce with the plans and FOOTING specifications and In compliance with all applicable codes and ordinances The Issuance of this permit does riot 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 If work Is suspended or abandoned for a period o1 180 days any time after work has commenced It shall be the responsibility of the permittee to assure all required inspections ar ques And approved. Permittee Sign tire Issued By GALL FOR 1NISPE16TION -649-417 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE 1 INSPECTION NOTICE City of Tigard Building '`epartment P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 TI 41 ype of Inspection 1c r v� n Date Requestecr__ Time A.M. _._.__P.M. ) � LA Address .l_l 1 ��/ Permit � Owner _.. Lot #_ ___.--------- Lt�O�'- Builder ---------�—•- --- ------- The following Building Code deficiencies are required to be corrected: i Presented to ____-_—- _____, Approwqd Inspector _ 1 1 Disapproved Date -- CALL FOR RF;INSPECTION ❑ YES U NO CITY OF TIGARD 639.4171 q830 5w �&.0 H-,�� 6328 BUILDING PERMIT DATE 9 16-J6 19 TAX MAP l_ l 1L1s_LOT NO. 3110 ..._—__SUBDIVISION owNER_�_ tctwuss Chevrolet hall 6 Garden Place JOB ADDRESS BUILDER _.-__1'6t4lil0unt Oil_Co. _ STATE REG.NO. _ EXP DATE BUILDER'S PHONE _ 644-5066 ARCHITECT- George wo Utten _-544-5066 PHONE _ OTHER STRUCTURE n NEW L; REMODEL U ADDITION f REPAIR C MOVE !p OTHER E jVjj... DEMOLITION I l RESIDENCE h GOMM F! EDUCATION IND RELIGIOUS I ' ACCESSORY GARAGE OTHER FENCE OCCUPANCY !AND JS'c TONE BLDG TYPE FIRE ZONE r'I..AN CHECK BY NEAT 1'i V dirxTr;xll, 10L : f-Iretu171'0.td.a SEWER PERMIT k OCC.LOAD FLOOR LOAD HEIGHT NO.STORIES AREk!""SUV NO.BEDROOMS VALUE U-1- �lJ BUILDING DEPARTMENT ; SETBACKS FRONT_ REAR LEFT SIDE RIGHT SIDE Permit r _19'�#00 (THIS PERMIT IS ISSUED SUBJECT TO THE REGULfTIONS CONTAINED IN THE BUILDING CODE. ZONING f REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES. AND IT IS HEREBY AGREED THAT THE Plan Check_ WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE. WITH ALL APPLICABLE CODES AND ORDINANJES, THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE PI Ck.Fire _ RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS TAX PERMITS.SEPARATE PERMITS REOUIRED FOR SEWER,PLUMBING AND HEATING. State Tax 7.72 SDC— Total 7W 72 APPL1CA1;i1ENT Prepd. - Receipt No. i'4';lX • ADDRESS 881,Due PHONE Issued By.__-—___.__-Approved By.__ _� DATE I R. TYPE INSPECTION REMARKS PLUMBING DATE Contractor / Permit No. - - Rough-in -- — ----- -- Fixture Final — — — HEATING ------ —' -- ------�-- Contractor -- --- Permit No. Gas orOil -- Rough in —_ `- Final -- -- — SEWER Final DRIVEWAY -" `-- Final - -- - -- —' Storm Drainage ---- (Rain Drain)Final - Sidewalk — Curb&Street Final Approach BLDG.DEPT.FINAL ! CERTFrEMPORARY NCY CERTIFICATICATE E OCCUPANCY Final Landscaping Zoning Final I t CITY OF TIGARCI 639.4171 NO.t —SUBDIVISION BUILDING BUILDING FERM'T TAXMAP ; LOT '•� `�� JOB ADDRESS � OVINEILP. TE °r STATE REG.NO. :UILDER*S UII..OER PHON —r' CJ �— OTHER ------ —' ' PHONE AW>IITECT ❑ OTHER Q DEMOLITION STRUCTURE O NEW ❑ REMODEL (I ADDITION C) REPAIR O MOVE (7 RESIDENCE O Comm C] EDUCATION ❑ IND O RELIGIOUS C]ACCESSORY ADE ❑OTHER ❑ FENCE SLOG.TYPE _ --FIRE ZANE_.�.—PLAN CHECK B OCCUPANCY LAND US ZONE SEWER PERMIT ^n ARE 'gyp BEDROOMS / (J J/�! OCC.LOAD FLOOR LOAD---- - RIC1liT SIDE BUILDING DEPARTMENT SET BACKS FRONT REAR Perml! ' THIS PETNTAINED IN THE NUILDING Coo*_ZONING MrT g ANp ALL SUBJECT TO THE RIEGULA,CODES AND OROINATIONS�NCM AND IT is HERESY AGREED THAT THE — THIS PER APPUCABLE AND gN COMPLIANCE REaWORK W1L1.BE DOME IN CO ES AND O pINANCES THE t85UANC THIS pfRMR DOES NOT WAIVE WITH ALL rM CbNTMGTOR AND SUB OONTRACTORS TO NAVE GNRRQ1r CITY BI{SINESS PI.Ck.F" TAX PE MIT TAX PERMfR SEPARATE I IMITs REOUIREO FOR SEWER.PLUMBING AND NEA State Tax SDC-- —----—— Total AppLICANT OR AG F.N T PDCJ Prepd. Receipt NO 'XDORESS Bal.Due issued _Approved By--- SSDC --- $ S o C --�-- POC — - SEWER CONNECtION S SEWER INSPECT ION SEWER SURCHARGE _S Comments: ' , "iaKtM71M�"`Mt� ,�±M^.�11E•""-•«w•�iw•l:•�r+rn�,rcwlrM:;yeb�. CITY JR BUILDING PERMIT APPLICATION TIGARD DATE 9'7 . 19 1. N2 0477 THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED OR AS SHOWN AND APPROVED IN ?'HE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE -- OWNER KnAkLILR Lh14 >. ADDRESS 11660 S.W. PSCifiClk BUILDER PHONE ENGINEER BUILDER POrtleirid FF,!nCa AR9HIT-9CT DESIGNEII STRUCTURE ❑NEW 13 REMODEL ❑ADO!TION ❑REPAIR ❑RENEWAAL ❑FIRE DAMAGE ❑DEMOLITION ❑ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CARPORT ❑GARAGE ❑STORAGE❑SLAP, ❑FENCE — ❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑S!GNS OCCUPANCY_ LAND USE ZONE BLDG. TYPE. FIRE ZONE— PLAN CHECK BY HEAT coDstruct approximately 1062 lin. ft. 69 high cheInlink — fence With three ntrantia barb wird topping a� OCC• LOAD— FLOOR LOAD HEIGHT NO.STORIES AREA VALUE BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE Permit - ---- THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING Plan Check REGULATIOAS AND ALL. APPLICABLE CODES AND ?RDINANCES, AND IT IS HEREBY AGREED THAT THE -- WORK WILL BE DONE IN ACCORDANCE WITH THE PL.ANS AND SPECIFICATIONS AND IN COMPLIANCE WITH Recording ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS 1%State 96 LICENSE. SEPARATE PERMITS REOUIRED FOR SEWER, PLUMBING ANI\ HEATING. Total 32.96 By P9 " -- �\PPL ICANL ON AGENT Approved f Receipt No ADDRESS -- -------- PIIOME I 1 Address�/� C.� Permit Noe __ /VW Permit charge Owner po�� Connection fee 3 _ Paid by_�__.....___.�._.._Y_.____._ p ` �O h l� Cl O _� Type of buildina N �"� Date conr�ec ted_ .�'�3 7/ Service rate /S oil Inspection fee v"15 Contractor / Paid by Date Size of connection � Assessment Paid ! ----------- hq f t� 1 1� il. Ef '7 t t PERMIT TO CONNECT Tigard Sanitary District PFRMiT N? 1414 DATE 71 __ r PERMIT IS GIVEN TO OF I tJ TO CONNECT TO THE STSTEM OF TIGARD SANIT_ART DISTRICT * AT THIS PERMIT MUST BE POSTED ON THE 6E.SCRIBED PRE SES UNTIL CON- NECTION 1S MADE AND INSPECTION OF CONNECTION HAS BEEN COM- PLETED. PERMIT FEE PAID !{.........;�......................TIGARD SANITART DISTRICT RX ..� CONNECTION INSPECTED AND APPROVED �1 Date Superintendent