Permit r
CITY OF TIGARD
PLUMBING PERMIT 13125 SW HALL BLVD.
P. O. BOX 23397
Applicants must hold Oregon Registration to conduct a plumbing TIGARD, OR 97223
business «must be property owner /operator not hiring outside help. (503 639 -4175 AA C�/ O /z�
Name of ��� Plumbing Permit No.
[�' ' Description
Address 99S4/i9ar /�c 74 w y ORS 814 -21410 OUAN. PRICE AMT.
Job Tax Lot Map. No.
Address FIXTURES
Lot Block Subdivision Si nk »W /1/ 7..50 .�/ OD
Name (or named business) Lavatory 7.50
Tub or TubbShower Comb. 7.50
hAaTing Address '
rOnny / 7.50 /, S()
Owner City /State Zp water Closet _ 7.50
Dishwasher 7.50
Phone Garbage Disposal 7.50
Name _ Washing Machine / • - -7.50 7, 50
Floor pram 7.50
_ : ass Plane � Water Heater 7 7.50
• �N _ - Laundry Room Tray . _ 7.50
Occupant City/State Zip 7.50
Urinal
Name Phone . Other Factures (Specify) 7.50
7/h, 'MC. / 7.50 -.0
Mang Address Phone 7.50
Contractor City/State DP 7.50
MISCELLANEOUS
City Bus. Tax No.
Sewer 1st 100' 30.00
- State MO. Board NI,. State Plumbers Bus. tic. No. Sewer -ea Addrt 100' 15.00
( Resdental) Water Service 1st 100' 20.00
J hinformation '
1 hereby acknowledge that I have read this a�pptication, that the information Water Service ea. Addiit. 15.00
given is correct. that 1 am registered with the State Balder's Board. and also • Stonn b Rain grain 1st. 10w 30.00
have a State Plumbing ioense that the numbers given are correct that all -
plumbing work will be done in accordance ordance with applicable provisions of Ore- Stone b Prim Drain Atka. 100' 15.00
gon Revised Statutes Chapters 447 and 693 and applicable codes end that . Moblie Home Space 25.00
no help will be employed unless licensed under ORS 691 (If exempt from
State registration, please give reason below). Bad( Flow Prevention
HOMEOWNERS -1 hereby certify that I em the owner of the property de- An
HOMEOWNERS 7.50
scnbed above. at whlch location I propose bmaksaptumbing Installation fa AnyTrepor Waste Not
my own use and this property Is not being constructed for sale, lease or rent. Connected to !=adore 7.50
Catch Bash% 7.50
kw. of Eidst. Plumbing 40.00 Per Hr.
- Specially Requested inspections 40.00 Per Hr.
Atter. of Plumbing within
an Existing Bldg. 15.00 min. •
AUTHORIZED SIGNATURE Date New Bldg. or Build. Addition • . • 26.00 min.
Rain Ekain,simle family- . • Describe work new ❑ addition 0 ahera no^i�s a r r ❑ Bening 15.00 t13 be done residential (1
Eidstrhg use of
building orix r t y $25.00 minimum SUB -TOTAL ' 99,ao
•= � of 5% SURCHARGE 4, SD
q t rp operty 25% PLAN REVIEW ,?,?SO
NOME
This pew* baoomis null and *old N work or construction authorized isnot corn- TOTAL - % / i DO
mind C wai 1$ O daya/ orIoonatinctbnor worlttselumperdedorebendonedfor
• period of 180 days at any erne alter work Is oorrwa:nosd.
INDSCtAL CONDITIONS • -
- Date issued by