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01/10/97 11:52 '$`503 684 7297 CITY OF TIG.ARD 4006/008
Fire Protection Permit Application Plan Check # I - i 25 (---
'QTY OF TIGARD Commercial or Residential Recd By ?LIAR
SW HALL BLVD. Date Reed -- - Z '11 1GARD, OR 97223 Print or Type Date to P.E. - x - 97
1 ;03) 639 -4171 Ext. 304 Incomplete or illegible applications not be accepted Date to DST - 3 "17
Permit ' Called W-/ - / 7
ame of Devel pment/Pro)ect No( E Type of System (Complete A or B as applicable)
Job 4 A.) Sprinkler Wet ❑ Address _ I .� 1) Q1 � Yt W � 7 1:-)T-7
,
� Stanepipes
L ffi/i17 ��i4f!i H azard G roup I ,�
Owner Mailing Address Additional /6/ 1
330 / /7i 4.t.6 = Information De l
Ci fate Zip Pnone Phone ?.d(o QO(
e�2' ce 4 61- g 9 z Design Area e
�. _,_ /�
Name �I�iM�l�i
K Factor
Occupant Mailing Address 3, 5
City/State zip Phone Sprinkler Project Valuation $ I . 0Y
COT Business Tax or Metro # Exp. Date B•) Fire Alarm @ 1, of1(9
Submitt2l Shall Include Battery Calculations - YES ❑
Contractor Ia. e •iiI- „ i L ILA / 2 Individual Component YES ❑
(Sprinkler or j ai Add s_., Cut Sheets
Alarm _ r (�YY 1 ,
Fire Alarm Project Valuation $ .l
Company) Ci IStatc I,� Zip Phone 3eo ler
k) ""' ` �t'•' - 6051a - 7 .WM. Project Valuation Subtotal (A or B) $ gyp
I A ttach of Copy 0/O/5L3 nt. Board Lk.* F�cp�Oa -7 £% , �Zd O�
� Permit fee based on valuaon _ _ -'S ;
Licenses �
Current COT Business Tax or MetrU It Exp. Date ( ij 4 ' ( see chart on ba ck) ti
-- _ 5% Surcharge I $
P 4) - 1� - FLS Plan Revie 40% of Su ; /tI
Architect Mailing 210 I la ^/ °
City/State hone ' (' TOTAL $
t hide u/i- f�d7 , l - LIja
Descrhe work A.) New Addition 0 Alteration O Repair 0
PLANS MUST BE SUBMITTED. appro+reo and a permA'ssued Prior to'nstacason.
Three sets or plans 2nD sae plan (and vicinity maw rewU'ree whim shows Iecalon of
to be done: nearest hydrant
B.) Basement 0 HoodNent 0 Spray Booth 0 `thereby atitnowiedge that I nave read this appricatAn. mat the inrom+amn green is
Complete tC• Partial 0 Exitway 0 cornet Mat I am the owner or authorized agent of the owner. and mat titans summed
are in compliance with Oregon State laws.
Additional Descnpuon of Work: " FI
r` S ig re of er1 • er Date
sy�em WPM- 132— , I / - 7' - , -- 7 A.) In Existing Building o New Building fl- Co P e on Nam Phone 369 a
Building _ ,C 6e 6 e y le 93 -& 6?;
Data B.) Commercial ❑ Residentid FOR OFFICE USE ONLY: _
Plat # Map/T1.#:
No. of Stories: " 1 0 -
Sq. t om : ,. �_3 -1 Notes
Occupancy task:: , • Type o C nstruction • •
'cststfiresupr.doc • - - 01_ - / .
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