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10300 SW GREENBURG ROAD STE 265-1 l � r.N'<j�1�M1 F aj/i•.'.�1�`aF�Y�4.1.111^'i!7�yA ,�� F C A' t�� 't 3 '1'f� ��� r'j�e�r ��lfy.�l�l. �•, fJi�'• ��V�i i M.•r -110— '00 1� 1• If •� Y 1 Iri ,• e N tr. l ee.. _ e - CITY OF TIGARD CERTIFICATE OF COMMUNITY DEVELOPMENT DEPARTMENT OCCUPANCY 13125 SW hall Blvd.Tigard,Oropon 97223u6199 (M)939-4171 PERM: •T #. . . . . . . A 8UP940043 DATE 46SUED: 08/23/94 i PARCELS 1 Ci 1?,,'�iAF3-_�1�1�►3 � 1 SITS., ADDRESS. . . : 10300 OW GREENf:AUF7G RD #S. 265 SUBDIVISION. . . . . 20NIN6.-C-'R LiIMOCt"..._._..._.... 3LOT ?...r_...____._...._ .,._____.._..__._.__..____....__....._.___.�..._ � 1 CI..PS9 OF' WORK. SALT TYPE OF USE. . . :COM ( OCCUPANCY GRP. :B2 II OCCUPANCY LOAD t 16 � j TENANT NAME. . . :MAYTAG Remarksi Maytag-- Tenant Mod: demo interior waits, acini interior walls. ne%-; ns f1.ni shat, Owner• _ __...._... .._.. _._----..._.._.._._. _...._.._.-.-...._ ` MEI....V IN MARK I 10220 JW l:;REE:NDURC RD T1G*ARA OF? 97223 Phone #: 45c"1-5900 Contr-actor: __.__,_.._._..__.._._......__..._. ........__.._._. .._____.__. M!~LVIN MARK CONSITRUCTION 10220 SW GREE:NHUPG RD SUI TFT #150 CIGARD OR 97(:123 Phone ##: 452--5900 Rer.I #. . : 64721 Ort:mpanr.y of the above referenced building is hereby given, and c^ert: ifies the compliance with the State Of ()regon Sppcialty C.adpr for the group, occupancy, and use under which the referenced permit was issued. I ;E'EI.TOR 11 L. 6/ F IAL ' POST IN CONSPICUOUS PLACE: I . tdt'f;. .. �• i `rte:�{+. INSPECTION NOTICE City of Tigard Baildinq Departnant 131.25 SW Hall Blvd. Tigard, Oregon 97223 Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 Inspection:— A Footing lbg. nderelab — Mech. {lough-in Appr/Sdwlk Found. Plbq. Top Out Gas Line PIi:AL: Post/Beam Struct. San. Sower Framing -Bldg. Post/Beam Mech. Rain Drairs Insulation -Plumb. Plbg. Underfloor QWater Lina Gyp. Bd. -Mech. Date Requested: r'_L3 Y Times __AM PM Address:_1_�Z i �� /t -"`.� a.a 1 L_ Permit f Builder: , 4 THS FOLLOWING CORRECTIONS ARE REQUIRED: i — Inspector=— �6CA Date: APPROVED DISAPPROVRD —__ APPROVED SUBJECT TO ADOVE i Call For Reinsp. F IL � r i NI SPFCfION NOTICF. City of Tigard Building Department 13125 SO Bali Blvd. Tigard, Oregon 97223 Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 , Inmprction: _ f ((' Y Footing Plbg. Underslab Koch. Rough- Apps/BdlLlk Found. Plbg. Top Out Cas Lino IKALt � ' Poet/Beam Struct. San. Seder Framing -Bldg. Post/Ream Mech. Rain Drain Insulation -Plumb. t:;a y�3 Plbg. Underfloor Water Line Gyp. Bd. -Koch. Date Requested:! I I / 1 p Timet (� AM i Address t "'� 'PD ALL n'� Permit i t i-Z'C"o `,,�C'/ Bu i lder: 1"`�I Usk, k, n r THE FOLLOWING CORRECTIONS ARE REQUIREDi �! V. wi°J �f / i I ti i inopPrtar: �p/� --- Date:__3 APPROVP.D DISAPPROVED /_�APPROVRD SUBJECT TO ABOVE _Call For Reinep. t 111SPECf1UN N(rICE - City of Tigard H1jilding Department- 13125 epartment13125 3V Ball Blvd. Tigard, Oregon 97223 Inspection Line (Rec-O•-Phone): 639-4175 Business Phone: 639-4171 Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk Found. (Mg. Top Out > Gas Line FINAL: Post/Beam Stru=t. San. Sewer Framiny -Bldg. Poet/Beam Neth. Rain Drain Insulation -Plumb. Plbg. Underfloor WaterLine Gyp.- Bd. �e _t,e,`ch/j. Date Requoattedt ]/ e) � Time: AM/7/_(�ray�_�1PM lddrees: Permit _1 Builder:l ] tv\ F`� w 21 '1 -1 1106 _ TBE FOLLOWING CORRECTIONS ARE RFQUIRED: k IntSpector. _Cz�PPROVED DISAPPROVED —— AppROVED SUBJECT To ABOVE _---Call For Reinep. .. .._..__...........,-...aru+nvcHrt..y.,vwerw r+evn..e.r..rn..r:nrvvner.A..,-_•..- - INSPECTION NOTICE City of Tigard Building Department 13125 SII Ball Blvd. Tigard, Oregon 97223 Inspection Line fRec-O-/Phone): 639-4175 Business Phone: 639-4171 Inspection: _------1 aL 1 I V\ Footing Plbg. Unders.lab Mech. Rough-in Appr/Sdwlk Found. Plbg. Top out Can Line FINAL: Poet/Beam Struct. San. Sewer. Framing -Bid 9• Post/Beam Mech. Rain Drain Insulation -Plumb. Plbg. Underfloor Water Llne // Gyp. Bd. -Mech. - I L/ Date Requested: Time: AM PM Permit Address: b✓�`� lJ► C Q. (�C� ��{l I ( C *r C)I `7t/-a)(0 �/J ii �/ Bu l l de r.:J r.3\ V\. 1 �-�/F.S t Z 2 �[ I l) THE FOLLOWING CORRECTIONS ARE REQUIRED: (� Inspector C T T Dater _-_—APPTcUVED ,- - DISAPPROVED _u APPROVED SUBJECT TO A _Call Por Relnsp. �i Nor— FF I CITY GF TIGARD COMMUNITY DEVELOPMENT DEPARTMENT 13125 SW Hall Blvd.Tiperd,Oropon 97223.8199 (503)839-4171 PLUMBING PERMIT PERMIT #. . ,. , . . . : PLM94-0029 6;393 -4 R 71 DATE ISSUED: 03/03/94 PARCEL: 1 S 13,5AR--01003 ~ SITE ADDRESS. . . : 1.0300 SW GREENBURG RD #S. 265 SURD I V ISI ON. . , . : ZONING: BLOCK, . . . . . . . . . . LOT. . . . . . . . . . . . . . CLASS OF WORK. . :ALT GARBAGE D I SPOSALS. , MOBILE HOME SPACE'S. : TYPE OF USE. . . . :COM WASHING MACH. . . . . . . : BACKFLOW PRE:VNTRS. . : OCCUPANCY GRP. . :B2 FLOOR DRAINS. . . . . . . : 1. TRAPS. . . . . . . . . . . . . . . FOR I ES. . . . . . . . .5 WATER HEATERS. . . . . . : 1 CATCH BASINS. . , . . . . . FIXTURES------- LAUNDRY TRAYS. . . . . . : SF RAIN DRAINS. . . . . : SINKS. . . . . . . . . . : 1 URINALS. . . . . . . . . . . . . GREASE TRAPS. . . . . . . . LAVATORIES. . . . . : OTHER FIXTURES. . . . . : � TUB/SHOWERS. . . . : SEWER LINE (ft ) . . . . : WATER CLOSEIc,. . : WATER LINE (ft ) . . . . : DISHWASHERS. . . . . RAIN DRAIN (ft ) . . . . : Remarrl(s : Maytag-- Tenant Mod : demo interior ;Halls, add inter-ior• walls, new finishes Owner: _____.--•--_-____-- FEES MELVIN MARK:, OWNER' S REP type amount by date recut 1022'0 SW GREENBURG RD PRMT $ 25. 00 JFI 03/03/94 - PL_CK $ 6. 25 JH 03/03/94 TIGARD OR 97223 5PCT $ 1. 25 .JH 03/03/94 - Phone #: 452-5900 Conteactor,: __.___-------.___...---.--.---......---•-___-- POWER PLUMBING CO } PO BOX 23144 TIGARD OR 9728 ___.__._.____.___.____________________•-__--_-- Phone #: 244--1904"4 $ 32. tJ0 TOTAL Reg #. . : 52378 -------- REQUIRED INSPECTIONfi This Perot is issued subject to the ,•egulations contained in the Tap-out Insp _M Tigard Municipal Code, State of Grp. Specialty Codes acd all other Final Inspection applicable laws. All wor( will he done in accordance with approved plans. This petit will expire if work is not started within IN days of i,suance, or if work is suspended for sore than IN (lays. P e r m i t:t e e S i g n a t�_u e :,• �K/ ,.__ _____-._ _ _. __ _ Issi_ted By: — - Call for inspection 639-4175 4w, LI City of Tigard PLUMBING PERMIT Planck/Rec. # 13125 SW Hall Blvd. APPLICATION Permit # Tigard, OR 97223 (503) 639-4171 ^ soripbori �-�- i amu , t:J/t/ ORS 81421-610 , QTY TPn1ICF? �AKMT Job /Czoo S,W FIXTURES Address .r ap '~ vatory olubr irwver MjZ. ---- Shower Only -- ... " Water- oset - Owne, (Nsliwasjw - S ° Garbage i"sal--- `- tt'- asNn9 Madine - 7.51 - Floor ram / 6 etre-FTenler -""?�- a♦ .,, T• -_ Occupant —Laundry m ray _ 10 -�- Q S�Ci �aJ _ JT nTn-a .50 zip _Othor-T,oures(Specify) .50 jContractor ' MISCELLANEOUSSewer Is1 foo• 30war-ea. L 100' •00a ve road this ap icabxi, sat le Water Service ea Addrt. - - Informallon givers is rxxrect,dial I am Mie owner or authorized agent of 200 15.00 the owner,that pians submitted am in comprranca with State laws,diet 1 Storm A Rain Drabs let 100' 90.00 -- am ragiatored with Min Conctrvcdon Contractor's Hoard,that die numbor given Is correct. 'll exempt from State Storm A Rain Drain Arlcfrt. -00' 15.00 v registration.please givo manor 1, below. Moble Nome Space 25.00 <I 1Back FFnw revanlan - --- Zo..'Z.� Device or Anti-Pollution Device 7.50 ` ny rap or Waste Not -- Connected to a Fixbrre 750 escn wo+cam re—new or.i n -n temhon repau as fo be done sidential Q non-residential Q —-- 0.00 Insp.of Exist.Plumbing per hr 40.00 FA-fing use of \ Specially Requested Inspections per fir building o•prorwirty, ")7 camam ram,single mr --------- -____ dwolfing 15.00 R se"nbal addbw prevention - Proposed use of dovicas 15.00 building or property �FaC<•pr TSr Rnf/AI 11C IOW -- prevention devices) NOTICE •Minimum Fee S25.00 S1113TOTAL r y as PEnMITS BECOME vo1D IF WORK on CONSTnUCi10N AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF S%SURCHARGE I __ CONSTnUCTION OR WOnK IS SUSPENDED OR ABANDONED - Fon A P'?nioD OF 180 DAYS AT ANY TIME AFTER WOnK IS PLAN REVIEW 2S%or SUBTOTAL COMMEN:ED. Special Conditions TOTAL 32 --- Uate issued by IT, *° * , • I M. l 1 I Y UF' TJGARD F21'.C�I4''T' I:)F� 6�NYMEN-1 ftL A -I.P 1 hll;l. a'14 c''4'►f� 0 { `• l..;4E L,K 0M1JUNT a 3c: . 51) AME a POWER 1=YI._UINP C rlt� CASH AMOUNT a 0. 00 TJ)"iRE,�iEi a Po BOX �'::�144 PAYMENT 1�A T t. SURWI V I S ION a TIGARD, OR 97 sF.31--3144 r1 F r URF�OS OF PAYMENT' AMOUNT PAID F'UFl�'CIFiF. OF' F'1�YIMk:NT taMC)t_1NI F�HII� LAMBING PERM MP.5. 00 PLAN CHF CK I`F T. BUILT) PER F AYTA(J ` Vi301 £3W UlikENBURU, #e6`i OTt-11. AMOUNT PC4IG _ _ ._ ._� 3.?. 50 � f4.w'•�..�.�....�._...".._....•.�.__.�...." ._.__ .._......."......... .._ n . ...._.��.-_-_.�.. �.-...�.._...�--..___--.�..�..—s."..a�.�.�.rr�.-ex..+.+_.�.rs..enT.Y1R'Y.CT.e,'.Yw.s,. �_.��...�:.F 1 1 I �dd l �9' INSPECTION NOTICF. city of Tigard Building Department 13125 SR Hall Blvd. Tigard, Oregon 97223 Inspection Llne (Rec-O-Phone): 639-4175 Business Phone: 639-4171 Inspection: ---------------._---- • Footing Mg. Onderalab Mech. Rough-in Appr/Sdwlk Found. Plbq. Trap Out Gas Lira FINAL: Poet/Beam Struct. Ban. $ewor Framing --Bldg. Poet/Beam Mech. Rain Drain Insulation -Plumb. Plbg. Undorlloor Nater Una 1� �Qyp• Bd� _dr.�ti, \ / � Date Requvateds 1 V -� I Times AM Ad dreass fn. 'Q_I/�W,iC,lf�i �� u'� Permft is v: Bulkier: 1' SUV((^ NSU �) )� ) ? `{j (` ,7 THE FOLLOWING CORRE-PIONS ARE REQUIRED: Inspector / Dates Z_7., APPROVED — DISAPPROVED APPROVED SUBJECT To ABOVE ---_Call For. Reinep. i f s� LFNSPECTION NOTICE City of Tigard building Department 13125 SU Hall Blvd. Tigard, Oregon 97223 Inspection Line (Rea-O-Phone): 639-4175 Business Phone: 639-4171 Inspection- Footing Plbg. Undersla:'3 Hach. Rough-in Appr/Sdwl.k Found. Plbg. Top Out Gas Lina FINALS Post/Beam Struct. San. Sewer framing I -Bldg. Post/Beam Mech. Rain Drain Insulation -Plumb. Plbg. Underfloor Nater Lina Gyp. Dd. -Mach. �/ Date Regueatedt 21(_ Liss A!t L` PM CA Levi r, 1 Addroas: l (lam V�1_AQ LIQ Permit #i Builder: r THE FOLLOWING CORRECTIONS ARE REQUIRED: Inspector:_�� -`J —_— Date:_,- i APPROVRD DISAPPROVED APPROVED SUBJECT TO ABOVE --_Call For Reinep. i Aft : 1r CITY OF TIGARD BUILDING PERM!" PERMIT #. . . . . . . : BUP94-0043 COMMUNITY DEVELOPMENT DEPARTMENT DA i L ISSUED: 02!1 b/94 ` 13125 SW Hall Blvd.Tigard,Oregon 97223.9199 (503),939.4171- 639 41 71 PARCEL: 1 S 135AB-01003 SITE ADDRESS. . . : 10300 SW GREENBURC) R1) #6. 265 m SUBDIVISION. . . . : ZONING; BLOCK. . . . . . . . . . . LOT'. . . . . . . . . . . . . . RE_I55UE; FLOOR WAREAS ----- ------ ---EXTERIOR WALL CONSTRUCTION— CLASS OF WORK. :ALT FIRST*. . . . : sf N: S: E: W: NYRE: OF USE. . . :COM SECOND. . . : 1550 sf PROTECT LPENINIUS'? TYRE OF CONST. :2FR THIRD. . . . : sf N- S: E: W: OCCUPANCY GRP,. :132 TOTAL—­­­:: 1550 s f ROOF CONST: FIRE PET" : • OCCUPANCY LOAD: lk'- BASEMENT. : sf AREA SER. RATED: sCOR. :5 FIT. -60 ft GARAGE. ., . : sf OC1 U SEP. RATED: BSMI.? :N ML_Z Z .) :N READ SETBACKS----,----- FLOOR ETBACKS----•-----1=LOOR LOAD. . . . :50 psf LEFT: ft RGHT: ft FIR SPKL-:N SMOK I)ET. . :N w DWELLING UNITS: FRNT: ft REAR: ft FIR. ALRM:N HNDICP ACC:Y BEDRMB: BATHS; IMP SURFACE: PRO CORR:N PARKING: VALUE. $ ; 20000 Rema;­ks : Maytag— Tenant Mod: demo interior walls, add interior walls, new finishes Owner: - ------------______.—______— ----.--___.....___.___.___..___._____..__._ FEES MEL_VIN MARK type amo{_Int by datk reept 10220 SW GREENBURG RD PRMT $ 140. 50 JH 02/18/94 — PLCK $ 91. 33 — 1212/14/94 94—,x'48891 T IGARI 1 97223 ... 5PCT $ 7. 03 JH 0,21 18 9 4 Phone trt 452-5900 Phone #: $ c?d. 86 TOTAL_ Reg #. . . -- -- — REQUIRErD INSPECTIONS ------- This permit is issued subject to the regulat+nns contained in the Fr-a m i n g I n s p Tigard Municipal Code, State of Ore. Specialty Codes and all other T n s,_t 1 at i on I r.s p 4 � applicahle laws. All work will be done in accordance with Gyp Board Insp approved pians. This permit will expire if work is not started S+_I s p Ce i 1 n g I n s p within 180 days of issuance, or if work is suspended for more Final Inspection ' than 188 days. Permittee Si nat{_Ire. Iss{aed By i Call for^ inspection - 639-4175 y. r figg, .Y. t D s milli I CITY Cli= 'T'T HARD - RE"CE=I EIT OF P*lr VMEN'1 RE'CE I FIT NCIn s94--;'.1/14135 CHECK AMOUNT s t 41, "r3 � AME RCIMME I._. AFICH[TF:I T'i..IRAL. CA13H AMOUN1 a IA. 1,110 flDREF3S 102,7+ SW TAYLOR STS SUITE. 360 PAYMEN1 DATE. a LAP/18/94 SUTAD T V 19 I UN PORTLAND, OR 97P05— m �URP0f4. OF VIAYME'NT AM(A IN 1 PA I D PURPOSE: OF P(AY111:::N T AMO INT V'A I D UIL DINCi� J40. 50 E;1 . t.4111A) Plw-- 2 i f AY TAG IA300 SW GREENSURG RD 11TAI.- AMOUN l" PAID -- - - - ) t 47, S:3 d !!i f ,;;�..;�• ,�' E', OL RJ � '_Q21 Ullt�y�� �nP� a iN I ` roes-Lzz-£U6 t:661-61-I�� a�C'.Ia �a �aE' UI/•, d �� r 661-z1-IG V '!' 9 W I W d111SUR-11MI f6-I-Tly 'K'aylnac-J S�JZ ��!nC� 'aajud-D ujoz)u!j auo "IVl-1ftUA— 11HO U V { �6-ZL-II a1e� �L���1CWSnZL6 HO �1114NOU r)� ume�4 09ins 6e169w :aWeu ally upl� Iool� .is aolm Ms ozor i a, o 3 _ o 0 z - - z o E � I I l r U U O E Y rO V)/ I , ° > — C. CL 00 M o •o f SoDN Dv — a N _ iv I ul- o ';� 3 T 7 c O a P - - - - - -- ---- m x w"o o x 7E, U GY W Z O v 1 w 0: U N E – OoWcr II C7 o x II I II As 1) III u ao r'� T > Y-? . o ° u u L �+o ^^-. Inv m � Z lJ I • j M 3 a 71'9 L C�L Q i Q 1] a Z N � O I 3E ° ; o 3o- 0 L F I IZ Z11 lf) �r7 idu h�3 u X.0 3 ar c a�.- N 0/ � u.E d U611V uz i x v C-= C C I v U i i <�+- II v� E a W.0 a L.n A M N C a. a '0.7 p v S-'Z_ L-.g ar a-0-0 o:: 01 a m u du.c} v� � 2e „ er oll ucao 2- tw v> u - E rn _ y. _ L .I •.0 .9 II C O O'A InC C C•1 �O O O� >O 1] 77 O'��_ a O 7 w� I` ICr in..O. 3•r E I. 1-�Y W— — �z �w N � Fo— z ui D r: norN i 1,r z uZ7O <7 000 vQ x �91 �� zZau�4cn r,lu O ou t0 3u v in O Z �t 7v I— pn �' um OjOm D wQ ca � o or ; CSI vv ro Ad X T r� Q O L M Z ��� ,a C a 0 co aL O 't a t17 L p\a O IcDJI CYC /lr 7lo W OL o ° .0 m V1 N Z 7 w o d u O 0 C Z7_n 7 1 �-- ---- ---—--- L- W ro u m J a E u >w > > C.7 a 7 a o CL �N � a 3 a 3 n d 1 I - j i i i cli i . ., r: liFl?�WIR+ts61AYl.!'{`�irYUAeenn«..,.v.,.,a.....-,•:........ .._. ... �y� ,� ;��`.{ 'd�N^ ,.",mild' ;; ti :�Pr.Yfdi9V� �i*d+waxt`�e»,+ q n tyBS—LZZ—COS - _ t'661 it I E6-I-ZI pay�na� c��� mins 'Ja�ua� u�a�ui� auv '1�`��1.���1.�ilou`� LZ-II SOZL6 NO 'ONVlI210d 13,11viou bP1SeW ;&weu al�� u��d �ui�ia� �a����Ja� is aouvi Msoioi IHI IN.L 40 - - --- 41 III p- -I0 -- X ." l Z �d, n� - - - 1. --- 1-- - - - - -- - -- q -� - - - j w din p. 1-1J: i r y ; t, i� yt l' yy t f 7r7G*1�,4 1, S`f , 1 Ll J'Y OF I .l UAND — REGF::1 E-I OF PAYM - T Hl i . .t F'1 IVi 1. 944-V48891 C"HECat NMt11.IIV l s 4 A. lli r 4AME s I^OMME.I, ARCH I TF"AJURAL- C3413,14 Nlh(1(1N I 4DDRE:SS s Ik*`0 SW TAYLOR ST, OI Ir'TF_ 360 F=INYMF'N 1 D141 F: ti LAPR/14/94 � ' PC1R'T't-AND, OR 9 7205-- ;:. �IURPC L OF PAYME.N T AMlIUN T' PA T 1) PURPOSE OF PAYMF N'I AMI)I IN 1 PAID M. ^'�1:I54N CHHX F=E=. 91. 33 II I ^ I � s %IY I(4[I 0300 SW URFENSLING RD, surr E,69, 1 TAL. AMOUN T FSA t D - — - _> 91 . 313 i .3 I S' a�11, _ AI 1 ' I k. 4 p - # v .}y,:} ,, Y. + ,p rm'.. r is •re it I •s. �Al AN M MMM R�a 13125 SW IMIDwd PLNCK/RECT a CITY OF �'IG.�.: D COMMON[TYbCVELOPMENI'pBPAItTA4GNT Tapntorcgon97U7 PERMIT (503)6.3"171 DATE ISSUED 10SOO SW �rcpnbur Acl- Suite 2(05 JOB ADDRESS: C'�vlc I� i �t Conte TAX MAP/LOT SUB: rn 4 LOT: _ LP. ,.......... ' VALUATION: 20FCC)C) OWNER SP __ NAME: Melvin Mnrk ?,5 rclk<-:agREISSUE OF: ADDRESS: v I(_'Z2o laW CreepfDLtr fid. LAST REISSUE: PC,rtILInd nr� Zz3 _ _ FLOOD PLAIN/ �r PHONE: (50 452. 5900 SENSITIVE LAND: _ CONTRACTQR APPROVALS REQUIRED NAME: _ �arrle n5. c-bo e ___--- PLANNING: ADDRESS: — �— 17.NGINEERING: FIRE- DEPT: PHONE: __.._ — _. OTHER: - --- -- CONTR. BOARD #: _ _ EXP DATE: ` ITEMS RF,QUIRED SUB_ CONIMCTORS: PLUMB: _ 1IST/SUBCONI-RACTORS: MECH: -� BUS TAX- ARCH/ AX: _ __--_---- - R�1 CII/E GINEER CALCULATIONS: _ NAME: _ Lcmwc-1 Arch. Ptnrsho. TRUSS UrTAILS: T ADDRESS: IpozC� `,bU lar• - SLII fe 3( C0 OTHER: — ----- - _ _101 lclY1d OK 97-205 PHONE: 227 - 5844 PRO, �D BLDG. USE: _ evicirl f r�- tpvcpnx c e Care ------ coMM,,,rs: Pkl;T s 3. RECEIVED APPLICANT SIGNATURE p0mrelej — - -- FEB .1 � 1994 Received By: Dale Received: COMMUNITY DEVEI OPMENT -- ._ AM I , ;tr >y I