Permit (178) CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permits►: MST2015-00244
s 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/06/2016
Parcel: 1S136AA14300
Jurisdiction: TIGARD
Site address: 10115 SW 67TH AVE
Subdivision: OAK STREET ESTATES Lot: 38
Project: Oak Street Estates, Lot 38
Project Description: New SF.
BUILDING
Floor Areas Reaulred Setbacks Required
Stories: 2 Bedrooms: 3 First. 1692 at Basement: 0 at Left: 5 Parking Spaces: 0
Height. 23 Bathrooms: 3 Second: 905 sf Garage: 417 sf Front: 20 Smoke
Dwelling Units: 1 Third. 0 sf Right: 5
Detectors: Yes
Total'. 2597 sf Value: $314,976.33 Rear: 15
PLUMBING
Sinks: 1 Water Closets. 3 Washing Mach: 1 Laundry Trays. 0 Rain Drain: 1 nna s.
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer. 100
Tubs/Showers. 3 Garbage Disp: 1 Water Heaters: t Water Lines: 100 Drains: 0 Catch Basins: 0
Bcher FixturPrevnes.
0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Fum<1001(: 1 Vents'. 0 Woodstoves: 0 Gas Outlets: 4
Furro=1001< 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less. 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea addl 500 sf. 3 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 1 401-600 amp: 0 401-600 amp. 0
601-1000 amp: 0 601+amp-1000v. 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio 8 Stereo: N HVAC: N Security Alarm: N Vacuum System: N Garage Opener: N All
Other. N Other Description: Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr.. Occupancy Group: Square Feet:
NEW SF VB R-3 2597
Owner: Contractor:
LENNAR NORTHWEST INC LENNAR NORTHWEST INC Required Items and Reports(Conditions)
11870 NE 99TH ST,STE 1170 11807 NE 99TH STREET SUITE 1170 1 Ersn Cntrl 503-639-4175
VANCOUVER,WA 98682 VANCOUVER,WA 98682
PHONE: PHONE'. 360-216-6423
FAX 360-258-7901
Total Fees: $23,605.40
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
bei done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is s ded for more the 180
days. ATTENTION. Oregon law requires you to follow the rules adopted by the Oregon Utility g3. .
T les re set forth in OAR
952-001-0010 through CA 2-0 You
a copy of the rules or direct questions to OUNC by cr 1. 00.3 2344.Issued By: PermitteeSignature:
Cali 603.639.417$by 7:00 a.m.for the next available InspecThis permit card shall be kept In a conspicuous place on the job site until ojectAppmved plans are required on Ne job sib at the time of eac
Building Permit Application G
Itt�§idential ov
7R-C
Ci of Tigard G�\ 10/15-
13125
13125rSW Hall Blvd.,Tigard,OR 97223 G ^ �� I fs
��/ L� lS OtherPermit: ( _ " 7Phone: 503.718.2439 Fax: 503.598.1969Inspection Line: 503.639.4175 O�Internet: www.tigard-or.gov OC `� t` / Supplemeohllnfarmaaoa
cl l
TYPE.OF WORK � REQUIRED DATA:I-AND2-FAMILYDWELLING
®New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement I ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
® 1-and 2-family dwelling ❑Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms: 3
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATIONNAND-LOCATION Total number of floors: 4
Job site address: 1611-T S (9 r C New dwelling area: �' s square feet
City/State/ZIP: (' pp QR 2722 3 Garage/carport area: 4 ) 7 square feet
Suite/bldg./apt.no.: I Project time: Covered porch area: 2 p square feet
Cross street/directions tojob site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COAIMERCL41-USE CHECKLIST
Subdivision: 0,9 -S - T '.S AT=S Lot no.:,38 Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION,OF WORK work indicated on this application.
NSFR Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name:LENNAR NW,Inc. Type of construction:
Address:11807 NE 99'a Street,Suite 1170 Occupancy groups:
City/State/ZIP:Vancouver,WA 98682 Existing:
Phone:(360)258-7900 Faz:(360)258-7901 New:
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business time:Lennar NW,Inc. lease re er is fmschedule
Structural plan review fee(or deposit):
Contact time:Charles Webb
Address: 11807 NE 991"Street,Suite 1170 FLS plan review fee(if applicable):
City/State/ZIP:Vancouver,WA 98672 Total fees due upon application:
Phone:(360)258-7900 Fax: :(360)258-7901 Amount received:
E-mail:PORPermits@lennar.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photovoltaic Solar Panel System.
Business name:same as above Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City/state/ZIP: Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: 195-307 Total fee due upon application: $201.60
Authorized signature: % This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Y�G�-s y Date: / y *Fee methodology set by Tri-County Building Industry
/
-11��.7L_I I `� �J "� Service Board.
C\BuildinglPermits\BUP-RESPennitApp.doc 02242011 440-0613T(11/02/COM/WEB)
L_
Electrical Permit Application `' wairaniouli is
Received
City of Tigard �G�\� Da aB,: Permit No: _C� y
13125 SW Hall Blvd..Tigard,OR 972 ^ Plan Review
Phone: 503.718.2439 Fax 503598.1.60 9 I-p15 Date/B Other permit
Inspection Line: 50J 639.4175 O�C n ReadyiB). )vdv B See Paget ser
Internet: wow.tigardotgov '``G a&Mcurod: SuPPlemental information
TYPE OF WOwll G PLAN REVIEW
❑New cons(Nction C]Aciclition/alteratirijekVW6ent Pleasecheck all that apply(submilIsets ofplans w/hems checked below):
❑Service or feeder 400 amps or mom ❑Building over three stories.
❑ Demolition ❑Other: where the available fault currenr ❑Madam and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or p Floating buildings.
_ - less to ground,or exceeds 14.000 ❑Commercial-use agneulmral
ElI-and^_-family dwelling ❑Commercial/industrial C3Accesson•building amps for all other installations. buildings.
El multi-family El Master builder El Other: ❑Fire pump. O Inslallarian of 150 KVA or
JOB SITE INFORMATION_AND LOCATION ❑Emergency m me.. W.-Elarger pmat2-.-1ely --. s>urnt
❑Addition of new motor lead c( ❑"A',-E-,`I-2'.'13",
Job net: Job site address: N ✓L: 100 minora. occupation.
_ ❑ or Six or more residrntiel units. ❑Recreational vehicle parks.
CIL)'t$[etC/ZIg: !� OR si ❑Health-care fadldies. 1:1 Supply voltage fm more than
7223 ❑Hazardous lannans. 600 vols nominal.
Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or mom.
FEE-SCRBDIJLE
Cross street/directions to job site: I QlyI ret -T raw
New residential single-or multi-faintly dwelling unit
/' Includes attached garage.
Subdivision: Oq s _ _ — _ Lot no.: 2p, 1.000 s9.B.or less 16854 4
Tax map/parcel no.: Fa add']500 sq.n.or portion 3392 1
Limited energy,residential 7500 o
-DESCRIPTION OF WORK - - (with above .RI -
Limiled energy M1111lfamfly 7500
residential with above .ft.)
Renewable Ene ❑ See Pig,2
Serrim or leaden Installation,alteration,■ndfor retocathim
PROPERTY OWNER Q TENANT. I200 amps or less 100.70
201 amps to 400 amps 13356 1 1 2
Name: !v 401 amps to 600 amps 200.34
Address: 118 601 amps to 1.000 amps 3o hill 2
aa / /� Over 1.000 amps m volts 552.26 2
(-IgrSlato'ZIP, q p Temporary services or feeders installation,aherstion,and/or
Phone: O ) J100' Fax:L7ko)a% -1-jo relocation
200 amps or less 59.36 1
Owner installation:This installation is bung made on property that own which is not 201 amps to 400 amps 16.08 2
intended for sale.lease.rent,or exchange.according to ORS 447,449,670.and 701. 401 amps to 599 amps 168.54 12
Owmer signature: Date: Branch circuits-new,alteration,orritension.per panel
APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee. 7.42 2
Business name: Lowit each brunch circuit
B.Fee for branch circuits svirlmm
Contact name: service or feeder fee,first 56.18
branch circuit
Address: NE IJ, c+_ 1I Each add'I branch circuit TA 2
Cih"Statc,Zl P: Miscellaneous serviceorreeder notincluded
Each manufactured or modular 67.84 2
Phone:( 1 — fax: : J
_� dwelling,service and or feeder
Reconnect only 67.84 2
E-mail: 'r' C Pump or irrigation circle 67.84 _
.CONTRACTOR Sign or outline lighting 67.84
Business name: w2.e�1. ;G�GGk.0
Signal cimun(slorlimited-energy See ,
anal,alteration-or extension Pa c 2
Address: Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25'hr
Cit):'State/ZIP: VOCI&XXIAInvestigation l l hr min) 66.251 hr
Phone:( A7 I 5.3 Fav:( 1 industrial plant(I hr min) 78.181hr
�y Inspections for which net fee is 90.00'hr
CCB Lic.: l6 Electrical Lie.: CTO Supry Lic.: 05 5 s ci6cally listed(Set hr mint
ELECTRICAL PERMIT FEES
Soon.Electrician signature,required: Subtotal:
Print name: `s r tie -�� s[z. Plan review(2596 of permit fee):
— Slate surcharge(12%of permit fee).
Authorized signatur . �O`U , TOTAL PERMIT FEE:
` 1 This permit application expires if permit u not almined winsin 18o
Print nano: �,i1� Q�Q �1�\o'eJ Date: data after it has been acarpted is,mmplim.
• NumberoflnsNctinns allowed per permit.
I Puil&ra,m,.11ELC.Pmnirapp ELR E.REduu Ro-05M,ZOU a U4615111105C066WM
l�
Mechanical Permit Application
Re eived
City of Tigard D DateBy PennrtNo.. O(
• 13125 SW Hall Blvd.,Tigard,OR 97223 \I Plan Review
Phone: 503.718.2439 Fax: 503.59$ � V Other Permit
Kr Dat fBy:
Inspection Line: 503.639.4175 V� C Date Ready/By: mri%:
Internet: www.tl ard-or. ov ® See Page 2 for
g g 9 't015 Notified/Method: Supplemental Information
DE
TYPE OF WO `O COMMERCIAL FEE' SCHEDULE - USE CHECKLIST
Mechanical permit fees"are based on the value of the work
®New construction ❑Additionfali: ent performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit,
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES-
I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist
❑Multi-family ❑Master builder ❑Other: Description Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
G/ Air conditioning1 46.75
Job site address: l all S_ _-5-w✓ 77,v 14 l/L7 Furnace 100,000 BTU(ducts/vents) 1 46.75
City/State/ZTP: 7 Z �' Furnace 100,000+BTU ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Pmjectname: Ductwork 23.32
Cross street/directions to job site: H dronic hot waters stem 23.32
Residential boiler(radiator or
h dronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
/- Flue/vent for an of above 23.32
Subdivision: Q� — C�S+TrE- Lot no.: g Other. 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 1 23.32
DESCRIPTION OF WORK Gas fireplace/insert 1 33.39
Flue vent for water heater or gas
NSFR Fireplace 23.32
Log li ter as 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
® PROPERTY OWNER ❑ TENANT Environmental exhaust and ventilation:
Name:LENNAR NW,INC Range hood/other kitchen
equipment 1 33.39
Address:11807 NW 990 Street,Suite 1170 Clothes dryer exhaust 1 33.39
City/State/ZIP:Vancouver,WA 98682 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 5 23.32
Phone:(360)258-7900 Fax:(360)258-7901 Attic/crawls ace fans 23.32
® APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name:LENNAR NW,Inc Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Charles Webb Furnace,etc.
Address: 11807 NW 991h Street,Suite 1170 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Vancouver,WA 98682 Water heater
Phone:(360)258-7900 Fax::(360)258-7901 Fireplace
Range
E-mail:PORPermits@Lennar.com Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name:
G 0 L C O_1 % PC U I (7' � MECHANICAL PERMIT FEES-
Address: iSTa / L / TI G Subtotal
City/State/ZIP: '—�� 177o Q Minimum permit fee($90.00)
/� Plan review(25%of permit fee)
Phone:(3031 6 6 7'1] 3B Fax.C4_13 ) fD 1_ igfl State surcharge(12%of permit fee)
CCB lie.: 2 2 U G TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as completes
Authorized signature: /'CawGirl ' Fee methodology set by Tri-Cowry Building Industry Service Board
Print name: r� _ w ,,U Date: 6 11:5
IlBuildin,,TermitsV C PennitApp 040113.dm 440 lTf(11/021COWWEB)
Plumbing Permit Application
1 1uilding Fixtures /`�'
` City of Tigard V� O�� ved
DateRecei/By: Permit No.:
13125 SW Hall Blvd.,Tigard,OR 909, 9�. Plan Review
■ Phone: 503.718.2439 Fax: 503.598.1960 c C rr In�� tc/ Other Permit No.:
Inspection Line: 503.639.4175 Q `�`vr4 a ate ReadyBy: Jnds. ld See Page 2 for
Internet: www.tigard-or.gOv OF \ Notified/MeNod: Supplemental lnformaton
TYPE OF WORK FEE* SCHEDULE
®New construction ❑D o tion For special information use checklist
Description I Qty I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft,for each utility connection)
CATEGORY OF CONSTRUCITON SFR(1)bath 312.70
® I-and 2-11amily dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 1 500.32
❑Accessory building ElMulti-family
Each additional bath/kitchen 25.02
E]Master builder ❑Other: Fire sprinkler C_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: ,�� SW CD 77-W vL Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 7-ea 01? q 722.3
Footing drain(no.linear It.:_) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: Page 2
Storm sewer(no.linear It.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: 0.4ffs -- 7q ES Lot-o.: 58 Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 1 25.02
NSFR Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name:LENNAR NW,Inc Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 11807 NW 99"Street,Suite 1170
Garbage disposal 1 25.02
City/State/ZIP:Vancouver,WA 98682 Hose bib 2 25.02
Phone:(360)258-7900 Fax:(360)258-7901 Ice maker 1 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:LENNAR NW,Inc Medical gas(value:$ ) Page 2
Contact name:Charles Webb Primer 12.51
Roof drain(commercial) 12.51
Address:11807 NW 991"Street,Suite 1170 Sink/basin/lavatory 5 25.02
City/State/ZIP:Vancouver,WA 98682 Solar units(potable water) 62.54
Phone:(360)258-7900 Fax::(360)258=7901 Tub/shower/shower pan 3 12.51
E-mail:PROPermits$Lennar.com Urinal 25.02
Water closet 3 25.02
CONTRACTOR
PL
Water heater 1 37.52
Business name: L CD;r /""Lu Water t m WV 56.29
p P PF/D
Address: /07 fSTO d CP�LU/Y/i3i/J tri r, 25.02
City/State/ZIP: ,fJD 7�f1 �^ / 70 d�Q Subtotal
Phone:(563)66 T"179 L-'X7 Fax'(50.3) to�0 7- eft✓ Minimum permit fee: $72.50
CCB Lie.: Z Plumbing Lie.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: L Dale: .5 This permit application expires Ila permit is not obtained within 180 days
after it has been accepted as complete.
'Fee methodology set by Tri-County Building Industry Service Board.
19asildinglPe,.a,TLMU-Penni,A,ci.c 10/01/09 4404616T(10/0VC0M/WEB)
City of Tigard
C01t11MUNPI'Y DFVI?I.OPbiF.N'I'DFPARI'I\IEN'F
Building Permit Review — Residential
Building Permit #: 42.h�&I5=uc:i�q
Site Address: /o i/S' S 1-d 6 -11-14
Alle-
Project Name: 6a-k 5"W&;-L-T F-s7*7ES Lot #: 38
(Ncwdwelling,-sabdn ision name,-Wditiun or Alteration=last name of owner)
Planning Review
Proposal: Nt-W SED
Verify site address/suite# exists and active in permit system.
❑ River Terrace Neighborhood: ❑ Yes No
Site Plan Elements:
C�1ltree (3)copies of site plan .xistmg structures on site
Bite plan must 12_4'on 8-1/2"x 11"or 11 x 17"paper 7Footpnnt of new structure (including decks)with finished
;:Inrawn to scale (standard architect or engineer scale) floor elevations
North arrow _,�tihn locations (required for neve,may apply for additions)
,OO ite address,project or subdivision name and lot number .ocation of%veils/septic systems
fZApplicant information (name and phone number) Z11rosion control (including drainage-way protection, silt fence
-BT.ot dimensions and building setback dimensions design,location of catch basin,etc.)
4-4:ut area,building coverage area,percentage of coverage and FXtrcet names
impervious area (applicable if R--,R-12,R-25&R-40) 12street tree size, type and location
IAC roperty corner elevations (2 foot contour lines if more than sisnng trees to be retained%with drip line,and tree
4 foot differentialprotection measures
,0 Clean Water Services —Service Provider Letter (lot platted prior to 9/10/1993):
Required: ❑ Yes,apphcant was notified �No Received: ❑ Yes ❑ No
Public Facilities Improvement(PFI) Permit:
Required: —�-r Yes,applicant was notified ❑ No -Applied For: ,' Yes ❑ No,stop intake
❑ band Use Case #: 54.)63)p Jy-qz�ool
Zoning: A-y,5,
Setbacks: Front '20 Rear 15- Side L Street Side I S Garage
, ' .;indscape Requirement: Al�# 00
Lot Coverage Maximum: ILI/f °o
i
J� Building I[eight: Maximum height 30 Actual I leight �3
Visual Clearance
Easements >VV.�
-'4�3"Sensitive Lands: ❑ Yes B�No Type
lrban Forestry Plan
Conditions "Met"prior to issuance of building permit
Notes:
1-7
Approved By Planning: z� TT Date:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approy-cd ❑ Not Approved
]:ABuildingAFonts,BldgPernutRvw_RES_070915.docx
Building Permit Submittal
Original Submittal Date:
Site Plans: # _�
Building Plans: #
Building Permit#: 0—L8 er budding,�pperm��it# above.
Workflow Routing: ❑ ng •. 'ngtneering ermit Coordinator L_ u lding
Workflow Sign-off 0-51�gnoff for Planning(include notes from planning review)
Route Applicat on Documents: eering: (1) copy of permit application, (1) site plan, (1) building plan and
original Ian review routing forth.
t ding: original permit application, site plans, building plans,engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: Date: / /5_
Engineering Review
C Slope at building pad:
Conditions "Rret"prior to issuance of building permit
Fisements (encroachments) per engineering conditions of approval and plat
Water Quality/Quantih facility:
Assess Water Quality Fee in-lieu: ❑ Yes ❑ No
Assess Water Quantip. I'ee in-lieu: ElYes El No
LIDA Facility on lot ❑ Ycs ❑ No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: Date:
Revisions (after Building Submittal only) RevicNver Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved, NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant-.
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant
SDC fees I?nrered: Wash Co'1'rans Dev 1ac 'es ❑ N/A
Tigard'prans SDC: ❑ Yes )9--N/A
Parks SDC: Ycs ❑ N/A
OK to Issue Permit
Approved by Permit Coordinator: Date:
I-Bolding Fonns B1dgPenm1RN"_Rt'S_070915.dncx