Permit CITY OF TIGARD MASTER PERMIT
' ' ' COMMUNITY DEVELOPMENT permit#: MST2020-00090
Date Issued: 04/09/2020
T F G AR Ly 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 1 S135CD02800
Jurisdiction: Tigard
Site address: 9550 SW LEWIS LN
Subdivision: BOETCHERS ADDITION TO GREENBURG I Lot: 6
Project: Nicholson
Project Description: Adding 682 sf of habitable space, including bathroom, above garage. TRADE PERMITS TO BE
OBTAINED SEPARATELY.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 22 Bathrooms: 1 Second: 682 sf Garage: 0 sf Front: 20 Smoke
Dwelling Units: 0 Third: 0 sf Right: 5
Detectors: Yes
Total: 682 sf Value: 883,517.72 Rear: 15
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Drains: 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Tvpes Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvcfFeeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'l 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Ecompasing: N
Other: NI Other Description:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R-3 682
Owner: Contractor:
NICHOLSON,JADE M OBRIEN&COMPANY LLC Required Items and Reports(Conditions)
9550 SW LEWIS LN PO BOX 4008
TIGARD,OR 97223 WILSONVILLE,OR 97070
PHONE: 415-309-8371 PHONE: 503-816-7736
FAX:
Total Fees: $3,670.67
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 503.232.1987 or 1.800.332.2344.
Issued By: �; 1t
f( /J2�- �( 2� Permittee Signature: �iJn ��— 7�' j�c�ti
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.
Building Permit Application
Residential RECEIVED FOR OFFICE LSE ONLY
City of Tigard MAR 12 2020 Uate s ! % 9: �G;
4 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.19 Date By: i 7 2oZd A.' Other Permit:
�I`�Y OF TIG HD
Ins lion Line: 503.639.4175 r. Date Rea /B ® See Page 2 for
TIGARD P� t,..tfOr•� Ready/By:Y g
Internet: www.tigard-or.gov BUILDING 'Notified/Method:7 7 p 1 Supplemental Information
iti
TYPE OF WORK �� REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
(Er/Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,an th prolt.for t e
CATEGORY OF CONSTRUCTION work indicated on this application. J
01-and 2-family dwelling ElCommercial/industrial Valuation: $
t
❑Accessory building El Multi-family Number of bedrooms:,
❑Master builder El Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: $Z
Job site address: R c c D 5,.,J Lt�, Lc, New dwelling area: CAA square feet
City/State/ZIP: U
( sue r)c.- a
ail)_--a_ Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: Covered porch area: square feet
Cross street/directions to job site: Plc /iv..�_ Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: I Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
4.?.`a Valuation: $
ed K 14 S d A N �)19-1.F ' g building area: square feet
-j- � P O L� New building area: square feet
f�l y`u
3
ROPERTY OWNER 0 TENANTNumber of stones:
Name: r�<J<_. 6>_ C Coe_ � -�J tS r,^ Type of construction:
Address: cC fS v S 4-./ op..—,3 Lo-�-..),- Occupancy groups:
City/State/ZIP: Ti "" `7 , Existing:
Phone:( ) 30. - S 3 Z t Fax:( )
New:
❑ APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:
Structural plan review fee(or deposit):
Contact name:
FLS plan review fee(if applicable):
Address:
Total fees due upon application:
City/State/ZIP:
Amount received:
Phone:( ) Fax::( )
E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: br t Submit two(2)sets of roof plan with connection details
n "' and fire department access,along with the 2010 Oregon
Address: ("6) .8 o r (q )J ce, Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review $180.00
ty W'`SO v``(L ��Q 7 t) (� and administrative fees):
Phone: rn
(�3 ) �l 6-- 7 7 3 r(� Fes'( ) State surcharge(12%of permit fee): $21.60
CCB lic.: /1 S a iQ i t''>! Total fee due upon application: $201.60
Authorized signature: _ ( This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Date: j}��p a *Fee methodology set by Tri-County Building Industry
Er-,`jr_ ri.,r/uls vService Board.
I:\Building\Permits\BUP-RESPernutApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling I ()R ofrl( I. [Si. ovI ,
111
City of Tigard Received
Dat
- Phone; 503.718.2439 Fax: 503.598.1960 Ass permit No.:
+ 13125 SW Hall Blvd.,Tigard,OR 97223 Associated
ociated permits:
TIGARD
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing ❑ Mechanical
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW v t, yo y. ii
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ 0 0
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0
3 Verification of approved plat/lot. 0 0 ❑
4 Fire district approval required. Name of district: 0 0 ❑
5 Septic system permit or authorization for remodel. Existing system capacity 0 0 ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. 0 ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ 0 ❑
9 Erosion control ❑plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ❑ 0 ❑
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ❑ ❑ El
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ❑ 0 0
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft. intervals);location of easements
and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and
surface drainage.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ❑ ❑ ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ 0 ❑
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- ❑ 0 0
floor,wall construction,roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings
and foundation,stairs,fireplace construction,thermal insulation,etc.
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. 0 0 0
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- 0 ❑ 0
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing 0 0 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ 0 0
systems,see item 22,"Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 0 0 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ 0 0
for four or more appliances.
22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or ❑ ❑ ❑
architect licensed in Ore•on and shall be shown to be applicable to the .ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". 0 ❑ ❑
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ ❑ ❑
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 ❑ 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ 0 0
27 "Drawn to scale"indicates standard architect or engineer scale. 0 ❑ ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 0 0
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 0 ❑
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, 0 0 ❑
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
1:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-613T(11/02/COM/WEB)
City of'Tigard
IIII COMMUNITY DEVELOPMENT DEPARTMENT
T I G A R D Building Permit Review — Residential
Building Permit #: _ - JQ,
Site Address: 5 5 0 SW' L-emit i Ln .
Project Name: (v icy)k 0150 n -A d cL t1 o rl Lot #:
Planning Review _
Proposal: /k 19Ov'Q eD C1 C-j € c%1 ci 4---4. iv r) 6. S 2_ S C-
lef
Verify address/suite#active in Accela. )21/In River Terrace: )2rf No ❑ Yes,River Terrace Review Addendum
Site Plan Elements: ,L1Erosion Control
,'3 copies of site plan on 8-1/2"x 11"or 11 x 17"paper tained-trees with drip line and tree protection measures
❑Drawn to scale(standard architect or engineer scale) ,Footprint of new structure(including decks) and FFE
North arrow )'tJtility locations&easements(required for new and additions)
tte address project or subdivision name and lot number 2Sidewalk/driveway approach
Applicant information(name and phone number) $Eeeatiau.nvells/septic systems
1Lot dimensions and building setback dimensions t.tree size,type and location
squareffS7751e716t5tage of buildings to be demolished ZI Street names
Existing structures on site p(orner elevations (2'contours if more than 4'differential)
C]L.,I a,...A,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ❑Yes/No
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes�No
f2I' Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified ra No Received: ❑ Yes ❑ No
Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: ❑ Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No
ADU applied for: 0 Yes ❑ No Received: ❑ Yes ❑ No
-Dlic FacIti.,° l.nprovement(PFI)Permit:
Required: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake
Ui—Land Use-Case#: 0 Zoning g 9 d S
,Required Setbacks: Front: Rear: 'S Side: - Street Side: i S Garage: �
', Building Height: � /� Max. Height: Actual H ht: .2.2--
Landscape Area: �/'v % Lot Coverage Max: N A"
Entrance (11 Set back no more than 8'from street-facing wall El Parallel to street or offset 45 degrees or less
Windows ❑ Minimum 12%of area of all street-facing facades
Garage ❑ Garage door is behind widest street-facing wall ❑ Yes ❑ No,one of the following is met:
❑ Door extends no more than 5'from wall and there is a covered porch extending beyond garage.
p f)P El Door extends no more than 5'from wall and there is a 12 sq ft.window above garage on 2nd floor.
v ❑ Garage door width is ❑ 12'or less ❑ 50%or less of facade ❑ 60%or less and includes 7 of following:
❑ Covered porch 0 Recessed entrance ❑ Wall offset ❑ 1'Roof eave El Roof offset
❑ Fire shingles ❑ Lap Siding 0 Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer
❑ Accent siding 0 Window trim ❑ Window recess ❑ Window projection 0 Balcony
earance 0 Urban Forestry Plan
0 S..ubidhe-mds: ❑ Yes ❑ No Type:
or to issuance of building permit
Notes:
7- Approved By Planning: ryi 1 A''- Date: 5/ 12-/ .7..0
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved 0 Not Approved
Revision 2: ❑ Approved ❑ Not Approved
I:1Building\Forms\BldgPemutRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: ,.C4z1.2j
Site Plans: # 7
Building Plans: # -
Building Permit#: ' nter building permit#above.
Workflow Routing: Planning fa-Engineering Permit Coordinator e..-g—Building
Workflow Sign-off: Q Sign-off for Planning(include notes from planning review)
Route Application Documents: ,E Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
,'Building. original permit application,site plans,building plans, engineer and
beam calculations and tru t details,if a plicable,etc.
Notes:
By Permit Technician: a e:
Engineering Review
[ 'Slope at building pad: 2 7
Er---Conditions "Met"prior to issuance of building permit n/
[Easements (encroachments) per engineering conditions of approval and plat h l4
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes Q.No
Assess Water Quantity Fee in-lieu: 0 Yes D No
LIDA Facility on lot: ❑ Yes LS i*10
EirPinal Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
2'Approved by Engineering: l✓�^^ f� Date: 3hl boze
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
1\1a-Conditions "Met"prior to issuance of building permit
❑ Approved, NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
›t-SDC Exemption: ❑ Received ,Pi--Does not apply
SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes 11 N/A
Tigard Trans SDC: ❑ Yes 14 N/A
Parks SDC: ❑ Yes N/A
LIDA ❑ Yes N/A
OK to Issue Permit
Approved by Permit Coordinator: AA"-
Date:Date: 3I le)120
1:\Bui Iding\Fonns\BldgPennitRvw_RES_122419.docx
i r4fsvizo_94 ddo90
Water Meter Fixture Unit Worksheet for Additians/Remodels/ADUs
Please complete the following information:
Customer Name: �f;rG , oka.,5u.-
Service Address: Street/Suite#: '1 S-S'‘) S c...J 6.e.,..,,i,s La-,
City: %i State: e5/c. Zip: ? 7. -a 3
Phone Number: Oils-) 301- 637I Email: n«,l-.oLsoi 3330 ..,n,,o,,`i.c i
Please fill in the number of each fixture you currently have. Please fill in tF e number of fixtures you propose to add.
Multiply the quantity by the point value to arrive at the current Multiply the quantity by the point value to arrive at
total. the proposed total.
Fixture Unit Current Point Current Proposed Point Proposed
Quantity Value Total Addition Value Total
Bar sink x 1 = x 1 =
Bidet x 1 = x 1 =
Clothes washer I x 4 = Li x 4
Dishwasher l x 1.5 = ►,S x 1.5 =
Hose bib I x 2.5 = a,s x 2.5 =
Hose bib, each x 1 = x 1 =
Kitchen sink I x 1.5 = 1, x 1.5 =
Laundry sink x 1.5 = x 1.5 =
Lavatory 3 x 1 = 3 I x 1 =
Water closet, 1.6 GPF ,3 x 2.5 = —1, c l x 2.5 = 9..g'
Bathtub/whirlpool x 4 = x 4 =
Shower stall 3 x 2 = (p x 2 =
Bath/shower combo x 4 = x 4 =
Current Points: Proposed Increase: 3. c
t,
Current Points+Proposed Increase= act.s =New Total Points =Req aired Meter Size g
Meter Sizes: 1 to 30 points=5/8" 30.5 to 37 points=%" 37.5 and over points= 1"
New Meter Size Needed for New Total Points: Cost: $ (see page 1)
Current Meter Size per Utility Billing: Cost: $ (see page 1)
New Meter Size Cost minus Current Meter Size Cost= $
(This is Your Cost to Increase Meter Size Due to Additional Fixture Units)
FOR OFFICE USE ONLY
Current Meter Size Confirmed with UB 'SJ ��' � c�```4r
Signature of UB Representative Date
I:/Bulldtng/Forms/WaterMeters 070119_Add.dOCx Page 2
Dianna Ornelas
From: UB Online
Sent: Thursday, April 9, 2020 2:28 PM
To: Dianna Ornelas
Cc: Erik Nicholson; #Building Permit Technicians
Subject: RE: MST2020-00090
Good Afternoon,
If the remodel is only for a half bath and no increase to the shower/bathroom then we can approve this as a 5/8 inch
meter with no changes.
Kind Regards,
Jill
Jill
City of Tigard-Utility Billing
■•§iy Senior Accounting Asst
TMAit
(888)826-7211 Payments
(503)718-2464 UB Main
jiflb@tigard-or.gov
(503)718-2494
13125 SW Mall Blvd.
Tigard, OR 97223
From: Dianna Ornelas<Dianna@tigard-or.gov>
Sent:Thursday, April 9, 2020 2:13 PM
To: UB Online<UBOnlinepay@tigard-or.gov>
Cc: Erik Nicholson <nicholson333@gmail.com>; #Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: FW: MST2020-00090
Importance: High
Hello UB Team,
Please see attached for approval of the water meter fixture unit worksheet. The addition of a bathroom does not result
in a meter upsize.
Can you please email your approval as soon as possible so that we can get this permit issued and out the door before
3:00 pm today?
Thanks so much for your remote assistance!
Dianna L. Ornelas(Howse)
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
1
From: Erik Nicholson<nicholson333@gmail.com>
Sent:Thursday, April 9, 2020 2:02 PM
To:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: MST2020-00090
Caution!This message was sent from outside your organization.
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail
may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained
by the City of Tigard in compliance with the Oregon Administrative Rules"City General Records Retention Schedule."
2
FOR OFFICE USE ONLY—SITE ADDRESS:
This form is recognized by most building depalt,nents in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
11111 Transmittal Letter
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
II--r,I I\-I
TO: ///0;s4,V DATE RECEIVED:
DEPT: BUILDING DIVISION CD
'RECEIV
FROM: MAR 2 4 2020
CITY OF TIGARD
COMPANY: ? BUILDING DIVISION
PHONE: ? By:8/
RE: i53.-6 Se-✓ r)
(Site Address) '� Yermit umf_
Project��rsu division name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and/or lateral analysis.
A Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
.2 Other(pplain): sus
REMARKS: //
FOR FFIC. USE ONLY
Routed to Per it Technician: Date: ;-2j `J Zc?� Initials:
Fees Due: Yes n No Fee Descri tion. Amount Due:
1/2— p(a,n C�V4--err, $ L S-
$ ,/
Special
Instructions:
Reprint Permit(per PE): n Yes .(No Done
Applicant Notified: Date: // `` Initials:
1:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012