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Permit .11 CITY OF TIGARD PLUMBING PERMIT 4 COMMUNITY DEVELOPMENT PERMIT #: PLM2006 -00481 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/16/2007 PARCEL: 2S 102AA - 03000 SITE ADDRESS: 08740 SW SCOFFINS ST ZONING: CBD SUBDIVISION: TIGARD HIGHWAY TRACTS LOT: 024 JURISDICTION: TIG PROJECT: HARRIS - MCMONAGLE HEADQUARTERS Project Description: Site utilities. CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: B FLOOR DRAINS; TRAPS: . STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: • TUB /SHOWERS: SEWER LINE: 68 ft WATER CLOSETS: WATER LINE: 129 ft DISHWASHERS: RAIN DRAIN: 295 ft Owner: FEES HARRIS - MCMONAGLE, SCOFFINS PROP.LLC Description Date Amount 12555 SW HALL BLVD TIGARD, OR 97223 [PLUMB] Permit Fee 7/12/2007 $320.80 [PLMPLN] Plan Review 7/12/2007 $80.20 Phone : [TAX] 8% State Surcha 7/12/2007 $25.66 Total $426.66 Contractor: MARLAND HENDERSON CONSTRUCTION 12950 SW PACIFIC HWY. #225 TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 639 -5537 • • Reg #: PLM 70266 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. 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 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. /szcedj_zcd.. Issued By: aeQ Permittee Signature: e rr? aiy , Call 503.639.4175 by 7:00 a.m. for an inspection that business day. / / 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. r o 'LA) 5 cc: FFINS ite Utiies `a - lumbine Permit Applicatir�n ry � ,. � �'� ` . � ' City of Tigard Date/BReceived y. /o /4 ob k Permit No.: 1.49606.ee 1 IU 13125 SW Hall Blvd., Tigard, OR 97223 i V 20 Plan D a t Review /�/_,� y. 11 Phone: 503.639.4171 Fax: 503.598 Other Permit No.: e/B c Inspection Line: 503.639.4175 D ate Read /B yy+�� ® p See Pa e 2 for rlcnl :l� ;�' Ready /By: � g Internet: www.tigard- or.gov r' ' 1∎ ; �` �� .Notified/Method Su lemeotal information TYPE OF W ORk. r . AN -c ` r'T� . ' FEE* SCHEDULE ❑ New construction " 7 Demolition • For special information use checklist. • Description i I Qty. I Ea. I Total ❑ Addition /alteration/replacement ❑ Other: , New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath . 0 249.20 ❑ 1- and 2-family dwelling ❑ Commercial /industrial ' - ' SFR (2) bath • 350.00 4 • a" SFR (3) bath , a 399.00 ❑ Accessory building ❑ Multi- family M . • ❑Master builder Each additional bath/kitchen 45.00 ❑ Other. Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities " 1 Job site address: 874' $G)„.5"c I ,40 d/ . Catch basin or area drain 16.60 City/State/ZIP: �� 4 97 Z3 Drywell, leach line, or trench drain 16.60 Suite/bldg./apt. no.: I Project name:hi-0,G c ZA- . O,yee Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes / 16.60 l', 6'i Rain drain connector 16.60 Sanitary sewer (no. linear ft.: _48 Page 2 S Storm sewer (no. linear ft.: Z54 Page 2 �D h iia • Subdivision: I Lot no.: Water service (no. linear ft.: a J' Page 2 / y7. Tax map /parcel no.: Fixture or Item Absorption valve 16.60 DESCRIPTION OF WORK _ Back flow preventer Page 2 IfiEd41 e7j 2 € .,•- 'Z 3'M /*/.�Y/ Backwater valve 16.60 Clothes washer 16.60 ' Dishwasher 16.60 GI OWNER ❑ TENANT Drinking fountain 16.60 Name: ��; y14( A7itfdT • Expansion tank 16.60 Expansion tank 16.60 Address: AZ.-- , / /,t�C�r Fixture/sewer cap 16.60 • City /State/ZIP: )! 7 fo o /ri 7Z.3 Floor drain/floor sink/hub 16.60 Phone: ( ) 6°.#7.---395=3.. . jy Fax: ( L/ .,301..../z..3. Z_ G arbage disposal 16.60 El APPLICANT ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State/ZIP: Roof drain (commercial) 16.60 Phone: ( ) I Fax: : ( ) Sink/basin/lavatory 16.60 Tub /shower/shower pan 16.60 E-mail: Urinal 16.60 CONTRACTOR Water closet 16.60 • Business name: ,%!.i y Ley 4 - p Water heater 16.60 Address: J o ,5s, : , S W "az ZS Other: City / State/ZIP: 7 - Z Subtotal ` ;ID Minimum permit fee: $72.50 Phone:. (�y 6, I Fax: ( Residential backflow minimum permit fee: $36.25 • CCB Lic.: ��f L 4, L a Plan review (25% of permit fee) A Plumbing Lic. no.: � t 3.0 State surcharge (8% of permit fee) ' , A a Authorized si a / ��� /�� «` / / /_/ TOTAL PERMIT FEE _� Print name• / / ;/% "- r,/- Date /Q-�3�� I This permit application expires if a permit is not obtained within JJJ methodology days after it has been accepted as complete. *Fee set by Tri -County Building Industry Service Board. • I:\ Building \Pennits\PLMU- PnmitApp.doc 06/26/06 4104616T(I0/02/COM/WEB) • Plumbing Permit Application - City of Tigard a '` Page 2 - Supplemental Information , . Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - 1" 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 Sewer - 1st 100' ! 55.00 C 3,601 to 7,200 $220.00 y C 7,201 and greater $309.00 Sewer - each additional 100' 46.40 . Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Storm & Rain Drain - 1st 100' 55 ' : Valuation: Permit Fee: 1 � $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' a / 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof to and including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for Inspection of existing plumbing or . ' . each additional $100.00 or fraction thereof to and including $50,000.00. specially requested inspections - per hour 72.50 Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. I 4 a ,. , • Fixture Work: Plan Review for Complex Structures • Are you capping, adding or replacing fixtures? If "yes", A "complex structure" is defined as an installation of a plumbing please indicate work performed by fixture. Failure to system that meets any of the following criteria. accurately report fixtures could result in increased sewer fees *. Please check all that apply. , Quantity by (Fixture) Work Performed ❑ Any new commercial building ., - Fixture Type: Replace ❑ Any new exterior plumbing site utilities. Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition Baptistry/Font of nine (9) or more new or relocated plumbing fixtures. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities - Jacuzzi/Whirlpool providing services to human beings. . Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service - Drive Thru facilities where new plumbing fixtures, including,interceptors, Cuspidor/Water Aspirator are being installed for the food 'service area. Dishwasher - Commercial ❑ Any new - residential building containing three. (3) or more - Domestic - . dwelling units. Drinking Fountain ❑ Any NFPA 13 -D multipurpose fire sprinkler system. Eye Wash Floor Drain /sink - 2" Submit 2 sets of plans with any of the above. -3" • -4" Car Wash Drain Isometric or Riser Diagram Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings Disposal - Commercial three (3) or more stories in height. - Industrial Ice Mach./Refrig. Drains Oil Separator (Gas Station) Comments regarding fixture work: Rec. Vehicle Dump Station , Shower -Gang -Stall - Sink - Bar/Lavatory ' - Bradley ` • ,_ .. -Commercial -Service . Swimming Pool Filter , . _ *Note: If the fixture work under tis permit results in an , • Washer - Clothes Water Extractor increase of sewer EDUs, a sewer p ermit will be issued and • Water Closet - Toilet fees assessed for the sewer increase must b paid before the Urinal plumbing permit can be issued. Other Fixtures: .- . . _ .. . i:\& dlding\Peuniis\PLM- PennitApp.doc 07/06/05 1 CITY OF TIGARD pLh42oo4 BUILDING DIVISION PERMIT #: .. 2 , 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 13/2212007 Phone: (503) 639 -4171 �ma Inspection Requests (24 Hrs.): (503) 639 -4175 �III INSPECTION WORKSHEET FOR DATE: 3/2112008 TIME: 7:01AM PAGE: 44 SITE ADDRESS: 08740 SW SCOFFINS ST CLASS OF WORK: SUBDIVISION: TIGARD HIGHWAY TRACTS LOT #: 024 TYPE OF USE: PROJECT NAME: HARRISMCMONAGLE HEADQUARTERS DESCRIPTION: Interior plumbing for new building. (4) floor drains are 2 ". (3) hose bibs; see other. 3114/08, ADDING (2) BACKFLOWS. OWNER: HARRIS - MCMONAGLE, SCOFFINS PROP.LLC, PHONE #: CONTRACTOR: WESTERN PLUMBING PHONE #: 003'63:3 -5296 Inspection Request Scheduled For: Date: 3/21/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 067070 -01 503 -.639 -6296 N Corrections /Comments/ Instructions: Ato l oatAt- .I Cdr ke avQ' PLwt 2,o o (-0 o y Q 1 Q L0 "F Sic L Oo A C ase� b w , PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: T1 �..w�� Date:3121 I 0 Phone #: (503) 718- CITY OF TIGARD , � {,. BUILDING DIVISION PERMIT #: PL.M2006 -00481 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/16/2007 Phone: (503) 639 -4171 I � I �° Inspection Requests (24 Hrs.): (503) 639 -4175 : INSPECTION WORKSHEET FOR DATE: 3/14/2008 TIME: 7 :00AM PAGE: 37 SITE ADDRESS: 08740 SW SCOFFINS ST CLASS OF WORK: SUBDIVISION: TIGARD HIGHWAY TRACTS LOT #: 024 TYPE OF USE: PROJECT NAME: HARRIS - MCMONAGLE HEADQUARTERS DESCRIPTION: SiU utilities. OWNER: HARRIS- MCMONAGLE, SCOFFINS PROP.LLC, PHONE #: CONTRACTOR: MARLAND HENDERSON CONSTRUCTION PHONE #: 503G3,35537 Inspection Request Scheduled For: Date: 3/14/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 066710 -01 503.639 -3453 N Corrections /Comments/ Instructions: ‘eleINVT 0wit 3J 1 0 1 0 NdT C v - ►-e-- . - - . 4/.7 c C ( � ..a�.. r co v-e -✓ S - r& E X 0 ./z) v-1 A t a.c, kw„ --\-v \ f.a te. f-a e O.rd.,cJ Co u4_,,e ►J -rs 0 ,s oLc tL `( co ✓ Sw-(._ re r-r S--d ✓ Cia4c'12 s j e JJ el) X e.i Pc i Atre,,+. ✓ ' L►a t ( i- t, /4- evev-r-ei ✓IEGv G P ( LA-dr) I:.e 1Cr�! T' /91 �i ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS JAL FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: (1 -w 1 \1 +a- Date: 3) I'4 I, DQ7 Phone #: (503) 718- CITY OF TIGARD • A BUILDING DIVISION PERMIT #: PLM200S -004f31 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/16/2007 Phone: (503) 639 -4171 r Inspection Requests (24 Hrs.): (503) 639 -4175 .' "'i � INSPECTION WORKSHEET FOR DATE: 3/10/2008 TIME: 7:00AM PAGE: 58 SITE ADDRESS: 08740 SW SCOFFINS ST CLASS OF WORK: SUBDIVISION: TIGARD HIGHWAY TRACTS LOT #: 024 TYPE OF USE: PROJECT NAME: HARRIS-MCMONAGLE HEADQUARTERS DESCRIPTION: Site utilities. OWNER: HARRIS-MCMONAGLE, SCOFFINS PROP.LLC, PHONE #: CONTRACTOR: MARLAND HENDERSON CONSTRUCTION PHONE #: 503 - 639 - 5537 Inspection. Request Scheduled For: Date: 3/10/2003 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 066340 -01 503. 6335537 N Corrections/Comments/Instructions: / Pow �✓a �C' L '�avy■e✓ COUei CIO ( ��u �u��" LAC) C l4 1 \. e ry t1 t. ,1: 8 a c; V 4 -‘ v [Val . J Coz - FT) e.„=-N- Co yJ e" S ±i.L Cr4u ire, ,A v1 Lz R 1 re.ne- c—C cr- � e e P Avect4) S L 11 • ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS A FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: ( ) )fi 1 Phone #: (503) 718- CITY OF TIGARD .. BUILDING DIVISION PERMIT #: PLM24060(4U1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/180007 Phone: (503) 639-4171 ti l Inspection Requests (24 Hrs.): (503) 639 -4175 _n IL.. INSPECTION WORKSHEET FOR DATE: 1p/312007 TIME: 7 :02AM PAGE: 19 SITE ADDRESS: 08740 SW SCOFFINS ST CLASS OF WORK: SUBDIVISION: TIGARD HIGHWAY TRACTS LOT #: 024 TYPE OF USE: PROJECT NAME: HARRIS- MCMONAGLE HEADQUARTERS DESCRIPTION: Site utilities. OWNER: HARRIS - MCMONAGLE, SCOFFINS PROP.LLC, PHONE #: CONTRACTOR: MARLAND HENDERSON CONSTRUCTION PHONE #: 503 - 6315531 Inspection Request Scheduled For: Date: 10/3/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 505 Sanitary sewer 056881 -02 503. 639-5637 Y Corrections /Comments/ Instructions: • DK PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: \A't •\\ - Date: 1 013 i tO 7 Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2006- 00481 11 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/16/21107 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 e7 I I INSPECTION WORKSHEET FOR DATE: 10/3/2007 TIME: 7:02AM PAGE: 20 SITE ADDRESS: Q8740 SW SCOFFINS ST CLASS OF WORK: SUBDIVISION: TIGARD HIGHWAY TRACTS LOT #: 024 TYPE OF USE: PROJECT NAME: HARRIS - MCMONAGLE HEADQUARTERS DESCRIPTION: Site utilities. OWNER: HARRIS - MCMONAGLE, SCOFFINS PROP.LLC, PHONE #: CONTRACTOR: MARLAND HENDERSON CONSTRUCTION PHONE #: 503.G39 -6537 Inspection Request Scheduled For: Date: 10/3/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 340 Storm drain 056881 -01 503639-5537 Y Corrections /Comments /Instructions: - �� 10' S-ht� -- J ts tkdt/ a'��" . arts; A2. .S ✓u,, , fir-, \Lc,,1. 54 �c.,..it/ Mold a1R. 3NC 1 fi-v` 4- Q lia:l { 1 Eti 44 e 1 rA 10 ' C -9a0 S IB U./nhv. c 0 a 4 , -,' I) f �l v-'u Co ..,,,..e lb ,. b ✓ r- ct;ve/ r3 a 1.‹,_ t. 0,1,„t, ❑ PASS % PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: (1b"1..- Date: 1 0 J.3 f - 7 Phone #: (503) 718- CITY OF TIGARD : BUILDING DIVISION PERMIT #: PLM2006 -00481 13125 SW Hall Blvd., Tigard, OR 97223 . DATE ISSUED: 7/16/2007 Phone: (503) 639-4171 ._-_- Inspection Requests (24 Hrs.): (503) 639 -4175 ..' °__.. • INSPECTION WORKSHEET FOR DATE: 9/25/2007 TIME: 7:00AM PAGE: 9 SITE ADDRESS: 08740 SW SCOFFINS ST CLASS OF WORK: SUBDIVISION: TIGARD HIGHWAY TRACTS LOT #: 024 TYPE OF USE: PROJECT NAME: HARRIS NAGLE HEADQUARTERS DESCRIPTION• Site uti lities: OWNER: HARRIS- MCMONAGLE, SCOFFINS PROP.LLC, PHONE #: CONTRACTOR: MARLAND HENDERSON CONSTRUCTION PHONE #: 503-639 -5537 Inspection Request Scheduled For: Date: 9/25/2007 Pour Time: ���/ Code # Inspection Description Confirm # Contact # Me age �" 335 Rain drain 056287 -01 503- 639 -5537 Y Corrections /C mments /Instruc ions: A4----- i • N -ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED OJ �J Inspector: �� Date: ! / �� Phone #: (503) 718 - I 1'14 -. * • Building Permit Application y�r017 :� 0, rty:,��;�, , , 4*57u . `y „F t �r pp � � ` tk'rT.7 J" R' FOR OF FIG EI14vUS 4 (ALL ilw t al:v1l ' * .w1 .i*Z1 *.2tI i ali: ,llr_ c 5[ 'f iraik 9- t +- ;Or:,; rti Irgt iii:P,7 s n., aa, �.r,`a PI(.. n' ` Received ` Permit Nb.. c 4 City, of Tigard D /B � ' a . ° • . / u ,. s ® 'r 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Date/By. Permit: F sTIGAIiD ✓ "F TT' " 1i Date Ready/By: Inspection Line: 503.639.4175 D Read J IZI See Attached Checklist for * ;Rir..;5cant Internet: www.tigard - or.gov Notified/Method. ) Supplemental lnformation TYPE OF WORK . REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all 0 Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. El � Valuation: $ .b , I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑ Multi- family Number of bedrooms: S. ❑ Master builder ❑ Other: Number of bathrooms: 7 .,) , JOB SITE INFORMATION AND LOCATION Total number of floors: ` - Job site address: C j4O S p ,P buff New dwelling area: square feet City /State /ZIP: / 6 rii.'4.3 J '7 2 2-, 1 Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: Covered porch area: square feet Cross street /directions to job site: e n —; (/ Z,�' ,, ,. J DU( it/4/742A Deck area: square feet ~?J t 2 OF L) 2 �n D 1 LA-4 Other structure area: square feet REQUIRED DATA: COMMERCIAL - USE CHECKLIST Subdivision: Lot no.: LAC . 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 y work indicated on this application. '� tid � t C E C-E 1 INA. C '-t - / �I.AL•j_., Valuation: $ Existing building area: square feet New building area: square feet %PROPERTY OWNER ❑ TENANT Number of stories: Name: L i q . t i S — ) . � Type of construction: Address: 6 1 2...C) 1 ) t,:-: .ILt - -H t /1 Occupancy groups: City /State /ZIP: Ti '1) Existing: Phone: (5 O '» G t7 ( 3 -g Fax: ( ) j ,4 ice C New: ❑ APPLICANT ❑ CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City /State /ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax: : ( ) E -mail: CONTRACTOR Business name: ' I . JA 1 1 _ BUILDING PERMIT FEES* Address: (Please refer to fee schedule) Structural plan review fee (or deposit): C ( s City /State /ZIP: Phone: ( ) Fax: ( ) FLS plan review fee (if applicable): CCB lic.: Total fees due upon application: 0 / Amount r eceived: e "9P . . `/ Authorized signature: - , L, Y o. 2 /7 ` ,jt 'i " - � This permit application expires if a permit is not obtained / / • within 180 days after it has been accepted as complete. L Print name: / f� i�� S „i 7.' S Date: /C j —,Cjh * Fee methodology set by Tri- County Building Industry Service Board. 1:\ Building \ Permits \BUP- RES- PermitApp.doc 03/21 /06 440- 46I3T(11 /02/COM/WEB)