14022 SW CHEHALEM COURT ADDRESS:
is\records\microfim\targets\building.doc
T1FICA7[ OF
CITY OF TOCCUPANCY
LOMMUN!TY DEVELOPMENT DSP .Fi T GERM'I • • • • . • • e MST93 0361t DATE ISSUEDe e 01 /PS/94
13125 SM Hall Blvd.Tigard,Oregon p7223*P1b9 ( 3')1&-4171
PARCEL: 2S 104 BA--04800
SITE:". 4DDRESS. . . c 14022 3W C:HEHALEM ur
SUBDIVISION. . . . e CASTLE. HILL ZONINC3t
BLOCK. . . . . . . . . . a t_OT. . . . . . . . . . . . . 10I9
CL..ASS OF WORK. a NEW
7 W'AE Of" USE'. . . t SF
OCCUPANCY GRP. c R3
OC�:UPANCY LOAD i 26 4
TENANT NAME. . . t
Rvmarksa e PATH I
Ownev,a
MLAAE!N aAR I c 1' t r
1,4795 SW OSPhE'
42 21
SEAVEPTON OR 91007
Phorte Me ;°579-134''1
ARALF. HOME'S/ML.ADE:N BARIC EVIC:
10480 sw EfwrR I DLII #t@6
f."OR'r_.AND OR 97P8"5
Phone Re 5-79-8471
Reg O. . a 78645
Orc.uE+e'-tcy of the above refwrpricod b1.lilding is hereby given , and certi.fiev,
1,►,e compliance with the Scatea Of Oregon Specialty Codes foo the grolip,
sac:cupainr-y, and uses under which they re r eerenc ed permit- was. i swueu.
1
F I r!E DEPARTMENT MCi I ECTOR
443,N 63
1 N 1.17NSP I WOUS PLACE
I
INBPtGTION NOTICE 1�
City of Tigard Building Department \,
13125 /R Hall Blvd. Tigard, Oregon 97223
Inspe%..-tion Line (ijc-O-Phone)t 639-4175 Business Phones 639-4171
Inspections.
Footing Plbg. Underslab Koch. Rough-in Appr/SdwlK
round. Mg. Top Out Gas Line /PIIp1Lt
Post/Seam Struct. Ban. Bower Framing
Post/Beau Koch. Rain Drain insulation -Plume.
Plbq. Underfloor Nater Lias Gyp. Bd. -Hoch.
Date Arquastodt 1 �� TimetPM
Add.cesse AA'' L Portsit tQ
Builders
THE FOLLOWING CORRZCTI(MS ARE R761RZD
N
Inepsctort� Dater
��APPNOYYo osBw-eROVEf) -_ APPROVED BU&MCT To ABOVE
Call For Reinep.
jNSysCTION 1=1
City of Tigard Building Department
13125 WE Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phane)i 639•-4175 Business Phones 639-4171
Inapectiont
Footing Plbg. Underalab Mach. Rough-in Apps/Ndwlk
Found. Plbg. Top Out Gas Line f t
Post/Beam Bsuct. San. Sewer Fraaing -Bldg.
Post/Beast Noah. Rain Drain Inaulation -Plumb.
Plbg. Underfloor Nater Line / Gyp. Rd.
Dato Requested._ L^��� "Z4 L;/ _ —Times - AM �(�PM
Addreu s� ;? Z e 1-` Pi�t'I fr%
I wFACrION NOTICE
city or Iigard Building Department
13136 Mf ga'l Blvd. Tigard, Oregon 97223
Inspection Line 1Roc-3--Phons)1 639-4175 Busins.a Phone: 63,'-4171
Inspectious—
t
Tooting Plbg. Underslab Nsch. Rough-in AM//rM1k
Pound. Plbg. Top out Gan Line
Post/Beam Bt"-uot. Ban. Aswsr yraminq -Oildq
Post/Beam Hoch. Rain Drain Insulation -11UKh.
Plbg. Underfloor Na�t7or Line 1 Z Gyp. Bd. -Rspb,
Date Requsstrd s 1 , 1_I -Cl J --Time:
Addrel..J�
es� ( '�_Z I �10 (Ar\ P@=Lt #,MeT 3 r
Builder:
THE FOLLOVING OCTRRECTIONB ARE REQUIREnt
L L4
bw
Inspecr_oct Dates / t ��7 -, 3
APPROVED DIBAPPROWn APPROVED SUBJECT Tc ABOVE
�s
call !oc Reins
WIM
INSPECTION poTIcz
City of Tigard building Dwpartaeot
13125 Sw Ball dltd. Tigard. Ocygr-,, 97223
Inspection Line (Roc-O•-Phone): 639-4175 Business Phones 639-4171
Inspections
Pootiny Plbg. Undorslab Mach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out oa_ Urn
lINAL:
Post/Bean Struct. Ban. Sower FramingBld
C g
Post/Beam Mach. Rain Drain Insulation / _pl ,—
Plbg. Ondorl7.cor `Nater Line Gyp. Bd. h._1�
Date Req�uosteds_ / Z
__ T1sN: PH
AM
Addre..:
Builders-� dll�//'��2"r —s�. J,�
TRE TOLLA7NING CORRECTIONS ARE REQUIREDA,
Inspectors
_APPROVED DISAPPROVED APPROVED SUBJECT To AboVE
Call For Roinsp.
rts@ 22 OP noTm
city of Tigard Building Department
13175 60 Hall Blvd. Tigard, OrwqPn 97223
Inspection Linty (Roc-U-phonolt 639-4175 Buain.aa Phonge 639-4171
Inspection:
Footing Plbg. Underalab Mach. Rough-in Appr/adwlk
Found. Plbg. Top Out Gas Line C ,)
Post/beam Struct. San. Rawer Fram/ng -Bldg.
Post/Beam Mach. Rain Drain Insulation
- -4lumr�
Plbg. Underflnor Mater Line Oyp. Bd. _Syph
Date Requested:tel Z- I O-q
Addrsaa: I , ,(n-z_ LYA0 Gln (IN _ Permit
Builder.:. r
TAE MLLON1No OD%mxcTIOlIS ARE REQUIRED:
141
Inapectorrr Datef �G r `'
_._APPROVED DISAPP)OVED APPWWRD SUBJECT To ABOVE
Xcall For Rel.nap.
SPECTItx1 ROTS - 00
*rd Building Departa,at
1312 Ilvd. Tigard, Ore7on 97223
Inspection Lina (R, .e)s 639-417' Business Phones 639-4171
Inspections
looting Plbg. Underslab Mach. Rough-in 4Vr/Sdwlk
round. Plbq. Top out baa Line lINALt
Post/Beam Struct. San. Sewer framing -Bldg.
Pont/Beam )tach. Rain Drain Innulat.ion -Plumb.
Plbq. Underfloor /Water Line1 gyp. Bd. -Koch.
Date Raquewteds �LL( �Z 1 1 Timet Alt — PM
Address: 7j
r ll • Q( Permit f t,U13 _
Builders_ \n a
THE FOLLOWING CORRECTIONS ARE REQUIRED,
4-115 t t-
PA
�- I S-rAZ QAJ o�'F L eine 1 1n�'E To _
, 1°Q Z„o
Inspectors
__tPPROVBD DISAPPROVED `4 APPROVED vuhiver TOABOV2
I
—_Call For Rainsp.
INBPF,CTION NOTICE
City of Tigard Building Departaumt
131.25 SM Hall Blvd_ Tigard, Oregon 97223
Inspection Line (Roc-0-1hor.3): 639-4175 Business Phone: 639-4171
Inspections
Footing Plbg. Underslab Mach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underit.00r Water Line Gyp. Bd. -Koch.
Data Requested: oll
� _ Timet AK PK
Addreee:1y L. -c
S 8 — moi Permit 1: d
Builder:_
TRE FOLLOWING CORRECTIONS ArR REQUIRED:
i
Ynape,tor�7"`-�� .---- --- DatR:._
APPROVED DISAPPROVED APPROVED SUBjMrT To ABOVE
Call For. Reinap.
INSPECTION NOTICE
City or Tigard Building Department 1\�
13123 ew Sall Sled. Tigard, Oregon 97223
Inspection Lina (Roc-4-Phonefs 639-41.75 Business Phones 639-4171
Inspections
lootlny Plbg. Undorslab Hach. Rough-in Appr/Sdwlk
Pound. PI-4. Top Out Gas Line PINALr
Post/Beam Struct. Stu. Sewer Praising ,+ -Bldg.
�osttseam Hoch. Rain Drain Insulation -Plumb.
01bg. Underfloor Water Line Gyp. Rd. -Hoch.
"at" Request/ods - / /� / Timer �AHAddreswp11
/'f U� Z ��/� '}
r ��'9L�"/� ) Permit is'" --
Builder:_
TBS FOLLOWING CORRECTIONS ARE REQUIREns
0.a.s
VW\- -�� -a�_Lam. `-E-L�l..s _C-,eiy V-1-e-A c"._�
V _
Inspector
�.^--^--
_ Deter �
APPROVED DISAPPROVED /
_y APPROVED SUBJECT TO ABOVE
—_—Call For Rei.nep.
MPECTION NOTICE (1
Ci.tl of Tigard UnilAing Dopwrtasnt
13125 BE Hall Blvd. Y_gard, Oregon 97223
Inspection Lina (Rorc-O-tPhono)s 639-41.75 Businerr ?hone: 639-4171
1 )
Inspection:_ �V (V14V --�,-- --
Footing Plbg. Underalab Hsoh. Rough-in Appr/Bdw,1
round. Plbg. Top Out Gas Line FINAL:
Poet/Beam struct. Ban. Bower Framing -Bldg..
Post]:*ea•4 Moch. Rain Drain _nsulat!o/��'� -Plumb.
P1bg Underfloof WaaterCLine oyp. Nd. -Hoch.
Date Requeered: ! I > 1� liaef AM Q cPM
JAddress:' ^1'[1^1 �.���14Z 11� _ Permit Of (p`2 7 DL//((o II
Builder:\ VA%t'cc,\j l( __�� ( —6 3 Vd L I
-A
THE 10LI.40NINo CORRECTIONS ARE
REQUIRED:
q t—cl u�J cJC_2L
I
C W \ ✓� Q r
Inspector:_ Date:
- i5
APPROVED
0I8"PPROVRO V APPROVED SUBJECT TO ABOVE
V Call For Reinap.
INSPECTION NOTICE
City of Tigard euildlng Departaent
13125 3W Ball Bled. Tigard, Oregon 97223
Inspection Line (Rec-0-Phore)e 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Underalab Nech. Rough-in Appr/Sdwlk
Found. Plhg. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain �IneulatIos -Plumb.
Plby. Underfloor Nater Line Gyp. Bd. -Koch.
Date Requested: - "'--s 3 —T-mat ---AM _PK
Address e 1� 0 4 Z' 'v"� ' _ Permit /e
r9Z FOLLOWING CORRECTIONS ARE REQUIRFD: ` JA.
i
au_
Inspectors___ f _'"�-'- Date:
APPROVED DISAPPROVED _ V_ APPROVED SURJRCT TO R00%7Z
Call. For Reinsp.
yxrPecrxQI rMISM
City at Tigard Building oapartmr`t
13173 M Hall Blvd. Tigard, Oregon 97223
Inspktion Line (Rec-O-Phona)r 639-1175 Business fhonac 639-4171
Inspections_
rooting Plbq. Underalab Mach. Ruugh-in Appr/Sdwlk
Pound. Plbg. Top O.,_ .:aa Line TINALs
Port/Beam Struct. San. Sewer treeing -Bldg.
Post/Beam Meals. Rain Drain IaaulatLon -Plimb.
Plbg. Underfloor Nater Line Gyp. ad. -Mech.
Date Request(iI ( Times AM pM
Address,_ +_�(.''LZ C,V�QYGIti-QVVA �J permit 9s`�_� ()2--V
A r 7�
Nullderr�G''�
POLL[1NIN0 O0RRECTI0148 ARE RXQUIREDt
Yee,-
21
►^C 3C _
- _ -a' c. 19�t wv- -
-7--OL, => >2
O)�
I
4 _.—.f--k� ` �, � Uj ms's �Q..- (v_ l�1 A
Inspectors -1'~"' Y
Dates—q- AA-53_
APPROVRD DISAPPROOVED V A►IIPROVRD SMIRCT TO AgOVR
L/Call for Reinnp.
INSPECTION NOTICb
CUT of Tigard suilding Department
12125 100 Ball slid. Tigard, Oregon 97223
Inspection Line (ROC-0-Phona)t 629-4175 Brsiness Phone: 639-4171
r
Inspections U- I V
Footing P1bQ. Under`e`laab Koch. Rough-in APer/Bdwlk
Found. i prbo. lou ouc /Can Line FINALt
Post/Beam Struct. \Ban. Bower /ft -Bldg.
Post/Beam Mach. Rain Drain Insulation _Plumb.
Ploy. Underfloor pater Lin. Gyp. 84. -Koch.
Data Rpuestedt_ ^1 �/+_
Addresst (C�LZ. C �i2-Y/G�L4 l�1 Permit #,�a— o 2 O
� dBuild.rt
TBs FOLLOWING CXMUWTIONB ARE REQUIREDt
i
Inspectors _ Dates-
"PROVED DISAPPROVED APPROVED SUBJECT To ABOVE
Call Vor Rainsp.
j,NBPECTIC6 NOTICI
Cit? of Tigard aril.ding Department
13125 Ba %all Blvd. Tigard, Oregon 97223
inspection Lina (Rwc-o-Phons)i 639-4175 Business Phones 639-4171
Inspections
Tooting Plbg. Underslab Neoh. Rough-in Appr/Bdwlk
round. Plbg. Te+p Out Gas Line % rIR11L:
Post/Beas Struct. San. Bower erasing -Bldg.
Post/Beam Na. n. Rain Drain Insulation -i?lumb.
Plbg. Underfloor Nater Lin1e Gyp. ad. -Neck.
Date Requested: '� IrJ Tlm03
Addreas.11(I02-2 dna tAA&- Permit #:
Builder:\ S O Y-r�CQ&
TAR FOLLOWING COMCfIONS ARa MUMM:
Inapsctor:__ Date
/APPROVRD DIBAPPROVan — — APPROVED SUBJECT TO ABOVE
T`Call For Rsinnp.
cit? of :spare Build"* Deportment
13125 BR Ball Bled. Tigard, Oregon 97323
Inspection Line (Aso-o-Phone)t 639-4175 Business Phoney 6j9-4171
Inspection_
looting Plbq. Underslab Meeh. Bough-in APer/Mdwlk
Pound. Plbg. 'top Out OU Lin& ANAL:
Post/seam Mtruct. Man. Bower
0fraBinq � -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbq. Underfloor Nater Line Oyp. Bd. -Mach.
Date Requested: C 1 AAv-) `l Time. _ lUl
Addreses_� � �(,1 2 C. �livV\ C� Permit se ,)y ,�_,,�.,.+r•
Builder:_`,1
TSB VOId.ONINO CORRBCTIONM ARB RBQUIRBDt
�� 9 <
Inspectors 0ate I O
APPRAaVRD APPROWD BUBJBCt TO ABOVR
!or Aoinep.
INBPICGTIQN NOTICE
City of Tigard Rodding Department
13125 OW hall alyd. Tigard, Oregon 97323
Inspection Lina (Roc-o-Phona)e 639-4175 Business Phonac 139-4171
Inspections
Footing Plbg. Underslab eoh. Rough-in Appr/adwlk
Found. `Plbg. Top cull
Gas Line FINALS
Post/Bea. Strut•:.. Ban. rower Fruinq -Bld
Post/Beale Nech• Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Lina Gyp. ad, -Meeh•
Data Rsquesteds �_'�1-�j Timer
-- �4, PN
Address: Permit fr �� Z
Builders
TRY FOLLOWING OORRECTIONS ARE REQUIRED:
010
Oo
S 4
Inspectors q p
_" Date
APPROVED _�DISAPPAOVED r APPROVED aUR.TECT TO ARO"`
--Call For Reinap.
IRE, CTIA BO?_%
City of Tigard Building Departure t
1312S awe Ball Blvd. Tigard, Orsym 97123
Inspection Lino (R.c-O-Phone)t 639-4175 Business Phone: 639-4171
Inspections
looting Plbg. Underalab Mach. Rough-in Appr/edwlk
Pound. Plbg. Top out Gas Line /IMALs
Poet/Boas Struct. ean. $*war Pressing -B1d4.
Post/Seas Mach. ain Drain Insulation -Plumb.
Plbg. Underfloor Mater Line Gyp. Bd. -Mech.
Data Requeslads Timms AM PM
Address, 1 Z Permit +> .� -D L kef
T
Builders
TBS IOLL0VING CORRECTIOMS ARE RBQUIREDs
Inspectors. .' _ Dates 3
11PPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
INBPECTION NOTICE
City of Tigard SaUdLog Departmant
13125 s0 Hall Blvd. Tigard, Oregon 97,23
Inspection Line7-0-Phonef r 639-4175 Business Phonisis 6.39-417,1
InspsctLonr K, 1 �J�
Footing Plbg. Undarslab Koch. Rough-in Appr/Sdwlk
Pound�x+� Plbq. Top Out Gas Line PINALr
Post/Baasl Etrtat,) Man. Bower Framing -Bldg.
Post/Eaar`Nawh. Rain Drain Insulation+ -Plumb.
Plbg. Underfloor Mater Line gyp. Ed. -Nsoh.
Data Requestedt �Z Tues ___�►N pN
!►ddrasa r rte,. Permit f r
Builders_ :�
THE FOLLOWING CORRECTIONS ARE RJW1REDr
Inspectors `�
_—_ Dater
APPROVED __ DISAPPROVED APPROVED SUBJECT TO ABOVE
Cell For Reinap.
W1210=f Haricz
City Of' Tigard RD-41,24 Department
13125 e11 Hall Blvd. Tigard, Oregon 97223
Inspection Line (Redo-.Phono)s 639-4175 Bu■ine■■ Phones 639-4171
Inspections
Footing Mg. Under■lab Mach. Rough-in Appr/Sdwlk
round. Plbg. Tap Out Gas Linw
FINALs
Post/Bean Struct. San. sewer Prising -Bldg.
et/Bean MeoA�) Rain Drain Insulation -Ply.
Plbg. Underfloor Mater Line gyp. Rd. -Meeh.
--
Date Requesteds_�� �-� Times AN PM
Addresses
�. � Permit ,scI7 L_J .
Builders
THE POLLORINa CORmcTIONs ARE REQUIRED:
- i
I
i
i
I
Inspectors Datvs���
APPROVED DISAPPROVED APPROVED SUBJECT To ABOVE
Call For Reinep.
NS ACTION NOfIC6
City of Tigard Building Department
13125 am Ball Blvd. Tigard, Oregon 97223
Inspection Line (Roc-A-Phone): 639-4175 Business Phones 639-4171
Inspection: — --
looting Plbg. Underslab Mech. Rough-in Appr/8dwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Boom 9truct Ban. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Mach.
Date Requesteds Times !IM —•—,QPM
Address: C7 z z__r � -�-' Permit #s,
Builder: —
TELE FOLLOWING CORRECTIONS ARE RRQUIREDs
' rC4
At
Inspector: Date:_
APPROVED _ DIS PP VED APPRLMRD SUBJECT TO AROVE
—Cal1 For Reinep.
INBPNCTION NOTION
City of Tigard noUd n Department
12125 W Nall Blvd. Tigard, Oregon 97223
Inspection Line (Rea-A-Phonw)s 639-9175 Business Phones 639-4171
Inspection: _
ting Plbg. Onderelab Hoch. Rough-in Appr/adwlk
Found. Plbg. Top Uut Gas Line FINAL:
Poet/Beam atruct. Ban. Bower Framing -Bldg.
Post/Beau Mach. Rain Drain insulation -Plumb.
Plbg. Underfloor Mater Lin�ej Gyp. Rd. -Neoh.
Date Requested@ �/�,�1��- 1 ((�� Times I!)U AN /- PN
Address, I1-4t�2Z �U'_'s�� I� `'-PPermit is -23 -0-3W
Builder:
THE rOLLONINO CORUCPIQNA ARB RNQUIRND:
Inspector:Y -' Date:
APPrArm DIBAPPROVND APPROVND SuSiNCT TO ABOVN
Call For Reinsp.
{ CITY OF TIGARD 4i; i:: .,
L17; .
4
71
COMMUNITY DEVELOPMENT DEPARTMENT r.591 c:-
13126 3W MaB Blvd.TIVard,OreW 97223.9199 (603)639 4171
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--CITY CSF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hal Blvd.Tipud,O►pon 27223•S1SS (503)639-4171 - a��- •�
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CITY OF TIGAR[1 ,;W�; Lrir1l
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Orogon 9722398199 (503)639-4171
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CITY OF' 'T'I GARD - RECEIPT OF PAYMENT RE=CEIPT NO. a 93-24203 4
CHECK AMOUNT 138 . 91S
ARBE CONSTRUCTION CASH nMOUNT 0. 00
Alil.jftE S e PAYMENT DATE:: 07/07r93,
SIJPD I V I S I CIN
URFOSE OF PAYMENT
AMOUNT PAID PURPOSE OF F'AvMI'N7 prdOlJNT P 1D �
ESU I I_D I NG PERM 382. ON PLUMES T NG PERM 140 00
ErC;HANICAL PE 43. 50 ST. BUILD PER 28. 28
'I_AIV CHECK FE 9. 18 PARKS SDC 500. 00
ITORM DRAIN GDC 280. 00
I
CIT 19 CASTLE HILL
14022 FW CHF'HALEM
OTAL. AMOUNT PAID — > 13AP. 96
i
...-,.- •ter-,
I
MATRIX
IV
DEVELOPMEN":
CORPORATION
CERTIFICATE OF PAYMENT
Received from A-12-& /. IQ ESS
the sum of $ �16 �— (check) for payment of the Traffic
Impart Fee on Lot/CASTLE HILL I .
Present this receipt to the City of Tigard at .the time you
obtain a building permit.
1993 MATRIX DEVELOPMENT rRP.
BY:
t:60 S.W. Hazelfem Road
Suite 100
Tigard, Oregon 97'24-7771
Phone(503)620-8080
Fax (503) 598-8900 T?gtfiX'7d]'iflkS,fl'' 4ipifirq C<",:rJ,thy'wNdi�h 3 "_T't` '�• _ ;!•
CITY OF TIGARD
w�.r; ;�:)�;;•h: ;r� 1.
COMMUNITY DEVELOPMENT DEPARTMENT ''' �`''1 ' '�• • • • • ' 1` ''���=
13128 8W Hall Blvd.Tigard,Oregon 97223.8199 (603)039.4171
1 OLD
4._r'. SW CHEHOLZM CT
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REOUi RE::L1
'IPpll�vt greet Apply N1L�, d. :PS ¢Ilii 1t`aUia _Cite bcC Wer" Inuu y61'Cf.1frr1
sewage Aje;ic)« The Pc y 1ik Gayg true
rte 4mild. ?i,e total aeount .f the __...
exotikes'. K`:F Ittrky does hot W:air anter 'the 3-.- , of the
ewer -eterais, 1` the sewer it -1aL rP' "Pasilreaenl
the Insiailer shAl( prospect 3 fent i,ections fr-as
staht:e p,vai. P" c. sQ luvei,ed, Ve :,stAi.ei ,hall purchase
"rde ;. E sit 411,1'
t� 4a.
Ca11 for* irl'Staection — 63 )-4175
3 - dqM �-
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CITY GF TIGARD T��O�«,97� PERMIT 6 /rlstf3-03G�
'COMMUNnY DEVELOPMENT DEPARTMENT
(50)639L4171 DATE ISSUED
.IDB ADDRESS: V ZZ- AY ' _ TAX MAP/LOT ZS 1 'qt �(BDC
SUB: �...TL F �4/1/ LOT:
.,Q�� LAND USE:
VALUATION:
SPECIAL NOTES
NAME: REISSUE OF:
ADDRESS: 0 w CSS P�Fy _�'+� ��I LAST REISSUE:
-6&,4V e-e-i o sj , FLOOD PLAIN/
PHONE: �� - �4� SENSITIVE LAND:
MTRACTOIt APPROVALS. REQUIRED 5L1D4"n.
NAME: rfC._ awl C'E�!e C �`6r� '�B F 1�-1e�1F� PLANNING: �9� iC�rd_�'----
ADDRESS: ie ___ ENGINEERING:
FIRE DEPT:
PHONE- S }�-�+'4 / _ OTHER:
.96-Irl UOLt�ie -
CONTR. BOARD A: -�vr�S^ EXP DATE: l2 13 ►'Ay wr- - jr1yi`aoo
ITEMS RE UIREQ
SUBCONTRACTORS: PLUMB: �tJ` 'L.: l LIST/SUBCONTRACTORS:
MECH: =�''s'�t'' BUS TAX:
ARCH NGINEER CALCULATIONS:
NAME: Z 4•2�Y Ti4-�T TRUSS DETAILS:
ADDRESS: o 'U�'� /�S ��' OTHER: -- -
Poz..1 1 6 12 _ --
PHONE: C4S -0 20 Z
PROPOSED BLDG. USE: _ �S/ K-17-
COMMENTS:
-17-COMMENTS: ��! A e4,) LNJ rn
aL
APPLICANT SIC"-'1
Received By: Date Received:
PERMIT # ACCT a DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
1-03& 10-432 (0 Buildiag Permit Fees l-9-& '. -3��- W
10-431 00 Plumbing Permit Fees of 00 ;;I
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5x) � •Zr
Building /U /
Pl imbing o O
F
Mechanical
10-433 00 Plans Check Fee
Building 62'1f,30
Plumbing
Mechanical /0
10-230 06 Fire
_`xA)R43-UA f cf 30-202 00 Sewer Connection
30-444 00 Sewer Inspection 3J� _
25-448-02 Commercial TIF Fees
25-448-04 Industrial TIF Fees _^
25-448-06 Institutional TIF Fees
25-448-03 Office TIF Fees
25-448-01 Residential Traffic Fees
25-448-05 Mass Transit TIF Fees 1/
52-449 OC Parks System Oev Charge (POC)
31-450 00 Storm Drainage Syst Oev Chrg
(SSDC)
24-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of) _
TOTAL
nm/3587P.WPF
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