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13350 SW ASH AVENUE Z!,00
CITY®FTWASD No. 058J
11,755 S.W. ASH JL—
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P.O.BOX 23397 DateJ._-LLIL
TIGARD,II OR 97223
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N&me 7
Address
Lot Block/Map S ivisionlAddress
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Permit M's Bldg. Plumb Cash Check
rr _
Scwer Other Other Rec. By
Acct. No. Descrl tib on Amount
10.432 Building Permit Fees
10.431.600 Plumbing Permit Fees
10.431-601 MachAnIcal Permit Fees _
10.230.50 State Bld . Tax
10.43_3_ Plans Check Fee _
10.435Other licenses & Permits _
30.443 _ Sewer Connection
30.444_ Sewer Inspection _
24.448 Street Sys! Dev. Charge _
25.149.610 Parks I Sit_Dev. Char e _
25.449.620Parks II Syst. Dev. Charge
__
31 '60 _ Storm Drainage SysL Derv. Charge
Business Tax
434 Alarm Permit --
10.227 Ball �-
10.455- Fines -Traffic/ IsdlPark Ing______,_
10.230- �_ C:PTA TrafficlMlad/ft. Asst.
10.456 indigent Defense_
30.446-401 Sewer ServIcelUSA _
30-446.402 Sewer ServlcelCity
31.447 Storm__Drainage
40.475 Bancroft Prin. Pymt.
40.471 Bancroft Int. Pymt. �.
1u-451 Other Char es for Services
TOTAL
'�- DEPT. l
his
I
iNC UIV;)Ef251rNCU 11`_HEUY Af rLILS ► UN i11't Ilnll 1 OH Illi. ,v'Jlln lu.H�uv t.P%I lU
OR AS ;HOWN AND APPROVED IN THE ACCOMPANYING PIANS ANDSPE�CIFFIICATIOVS, ovrTVER.'t
LOT NO
."CIIITECT
IC.X `''E/'1GINEEit
DESIGNER --
c ❑FIRE DAMAGE LJOE:,dpLlt
iTf1UCTURE - NEW_ ®AEti1�10EL -V_❑aUOIfION ❑-tRe.P:.IR ❑REN_';�r1.-�11TL -
r nESILIE"ICE ❑COrtM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS UPATIO OCAR PORT `JGARAGE ❑STORAGE❑SLAG UFE
CCC(�A�jCY_g_} LANO USE ZONe - OLOG.TYPE_5N _ _ PLAN CHECK By---.
BATHROOM-r-- BEDROMI -
SEt:IER PLR FIIT I-jZ -t� — - .�- -- -
V"L Lo_D FL�g l�gp }IE BHT—�f- N(�ST0RIES AREA _- NO-BEQg00ktS4m- VALU
5')1LOIN•; OEPARrmENr SETBACKS FRONT +.A+ REAR dow� LEFT SIDE oP - RIGHT SI fi` ^_
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZOI
I �n Chrck / REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT
r-- WOaK WILL BF. DONE IN ACCORDANCE.WITH THE PLANS AND SPECIFICATIONS AND IN CGf IPLIA.N:,F
5'.17 l3(JI II ALL APPLI^.ABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT W.
RESTRICTIVE COVENANTS. CONTRACTOR AND SU9 CONTRACTORS TO HAVE CURFENT CITY BtMil
C:;st^ Taxr/I -v LICENSE. SEPARATE PERMITS REOUIRED FOR SEWER, PLUMBING AND HEATING.
Total I
SOC -
r PDC#
�'` APPLICANT OR AGENT
(�Approvm I Receipt No
SDC (Storm
SDC----
POC
SEWER CONNECTION $
SEWER INSPECTION S
SEWER SURCHARGE $
Comments :
Address 1_ .5V SGS_�} !�'�----— - Permit No.-`9--� --_ —_—_
Name of Occupant _ Permit charge —_--
Connection fee—
-.�.__ - --- — --- — Paid by -- -- _
Date connected
Type of Building _ _ . . Inspection fee
--- --- - _--- ._
Service Rate_-- --__ - -- -----W_-_ _-- Paid by --_ -- -Date--.—
Contractor
ate_ ._Contractor_ -__ __- Assessment—.._f_^
Size of connection
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PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N9 919 DATE
PF:Rlii17' IS GIVEN TO
OFTO CONNECT ATO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $.... ...........................TIGARD SANITARY DISTRICT
BY ---__�--.—_. — —
CONNECTION INSPECTED ARID APPROVEY
cS` CO
Date__.__ _ Superintendent