Permit 02/17/2004 13: 34 5036501918 _ - ELECTIC PAGE 02
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CITY OF TIGARD
13125 S.W. HALL BLVD. RECEIVED
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE FEB 1 '/ 2004
D + L ELECTRIC, INC. CITY OF TIGARD
PO BOX 1047 BUILDING DIVISI9A
OREGON CITY, OR 87045 j i
Electrical Signature Form
Permit #: ELC2004 -00008
Date Issued: 1/9/04
Parcel: 28110DC -00700
Site Address: 11205 SW SUMMERFIELD DR
Subdivision: WILLOW BROOK FARM
Block: Lot: 016
Jurisdiction: TIO
Zoning: R -25
Remarks: Sign lighting.
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical permit to be valid. the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Division.
No electricalI inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
HOLIDAY RETIREMENT CORP D + L ELECTRIC, INC.
PO BOX 14111 PO BOX 1047
SALEM, OR 97302 OREGON CITY, OR 97045
Phone #: 503 - 370 -7071 Phone #: 656 -5623
Reg ##: SUP 2662S
LIC 88069
ELE 3 -1610
AN INK SIGNATURE IS REQUIRED ON THIS FORM
. �,, , / ^
Sig ature of Supervising Electrician
If you have any questions, please call 503.718.2433.