Correspondence CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
COLUMBIA MECHANICAL INC
1702 DIKE RD
WOODLAND, WA 98674
Plumbing Signature Form
Permit #: PLM2002 -00048
Date Issued: 512102
Parcel: 2S114A0 -01500
Site Address: 17005 SW 92ND AVENUE
Subdivision:
Block: Lot:
Jurisdiction: TIG
Zoning: R - 12
Remarks: Maintenance Building - Phase II of Cook Park Master Plan expansion. The (2)
floor drains are 2" aand the other fixtures are (3) hose bibs.
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return
this Plumbing Signature Form prior to the start of the work .
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
TIGARD, CITY OF COLUMBIA MECHANICAL INC
13125 SW HALL 1702 DIKE RD
TIGARD, OR 97223 WOODLAND, Wn, 98674
Phone #: Phone #: 360 - 225 -5761
Reg #: LIC 151122
PLM 37-451PB
•
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Si 1
nature of uthorized Plumber
If you have any questions, please call (503) 639 -4171, ext. # 310