Permit (26) CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit#: SWR2019-00048
13125 SW Hall Blvd.,Ti Date Issued: 05/23/2019
T f C.rt R. and OR 97223 503.718.2439O 9
Parcel: 2S 115AB08000
Jurisdiction: Tigard
Site address: 11155 SW GABRIEL ST
Project: Willow Brook,Lot 25 Subdivision: WILLOW BROOK SUBDIVISION Lot: 25
Project Description: Sewer connection for new SF.
Contractor: Owner: PACIFIC LIFESTYLE HOMES INC
11815 NE 99TH ST STE 1200
VANCOUVER,WA 98682
PHONE: PHONE: 360-573-8081
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 05/23/2019 $5,650.00
Type of Use: SF Sewer Inspection-Residential 05/23/2019 $35.00
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $5,685.00
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable
law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if
work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification
Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions
to OUNC by calling 503.1987 or 1.800.332.2344. /J� j�y
Issued By: G�% �� � Permittee Signature: =G�(�if/ ike r 06/1-1-
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.