Permit CITY TIGARD SEWER CONNECTION PERMIT
�c DEVELOPMENT SERVICES PERMIT #: SWR2002 -00112
III
pc 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/6/02
SITE ADDRESS; 09591 SW WASHINGTON SQUARE RD PARCEL: 1S126C0 -01107
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: VICTORIA'S SECRET
USA NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: .7 EDU increase
Owner: FEES
PPR WASHINGTON SQUARE LLC Type By Date Amount Receipt
P.O.BOX 21545
SEATTLE, WA 98111 PRMT CTR 3/6/02 $1,610.00 27200200000
Total $1,610.00
Phone:
Contractor:
Phone:
Reg #:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180
days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee
the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect
3 feet in all directions from the distance given. If not so located, the installer shall purchase a "Tap and Side Sewer" Perm
/
Issued by: Permittee Signature: Uvk
Call ( 03) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Accumulative Sewer Tally
Tenant Name: Victoria's Secret This SWR# 2002 -00112
Site Address. 951 SW Washington Square Rd This PLM# 2002 -00054
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptisery/Font 4 0 0 0 0 0
Bath - Tub /Shower 4 0 0 0 0 0
- Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 1 1 1 1 1 1 1 1
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 2 4 2 4 3 6 3 6
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 48 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
- Oil Sep (Gas Station) 6 0 0 0 0 0
, Rec. Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
.Sink - Bar /Lavatory 2 3 6 2 4 2 4 3 6
- Bradley 5 0 0 0 0 0
- Commercial 3 0 1 3 0 -1 -3
- Service 3 1 3 1 3 1 3 1 3
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 2 12 2 12 4 24 4 24
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 9 26 9 27 11 38 11 37
Current Fixture Value 37 divided by 16 = 2.3 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 26 divided by 16 = 1.6 Previous EDU
Change 11 divided by 16 = 0.7 over (under) $ 1,610.00
Enter EDU Change Here 0.7
HISTORY
Notes: PLM# EDU# SWR#
PLM# EDU# SWR#
PL ■ • EDU# SWR#
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, �Signa�tu�re�of perss_ko that - at this tally sheet and date perfromed is required A ,
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