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INSPEC.'TION�IOTICE
City of Tigr-e Building Depar•twant
23125 80 Hall Blvd. Tigard,
Oregon 97223
Inspection Line (Rec-O-Fhons): 539-4175 Business Phone, 439-4171
Inspection,
Footing 1'l'.y. Undorslab Mach. Rough-in Appr/Sdwlk.
Found. dlbg. Top out Gas Line
FIN:iL,
Post/Beam Struct, San. Sewer Framing
Post/Beam Mech. Rain Drain Insulation Cpl ~
Plbg. Underfloor Nater Line
app. Bd. -MOL-ch.
Date Requested e eq Tion l'
Addreael
aI 'S �~ � pexuit
Builder:
THE FOLI"AING CORRECTIONS An REQUIRED,
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Inspector, --
Date:
APPROVSD DI8%PPROVLf APPROVMD SUR.JT.CT To ABOVE
C .or Reinnp.
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City of T.igas.•d Building Department
13125 611 Rall Blw.A. Tigard, Oregon 9722.1
Inspecti..n Line (Roo-O-Phone)s 639-4175 Business Pho, ^t 639-4171
{
t Inspections_
Footing Plbg. Inderslab Mach. Rough-in Appr/Sdttlk
I vcvnd. Plbg. Tc p Out Gas Line FIN":
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Post/Beata Struct. San._Eft ar` Framing -Bldg.
Post/Beam Mach. Rain Dials/ .Insulation _Plumb.
Plbg. Underfloor Nater Lina Gyp. Bd. -Meeh. M
Date Requesteds � Times
Addresss�'��. _�' v 1 I Permit
Builders
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� THE FOLLOWING CORRECTIONS ARE REQUIRED: •c,
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Inspectors Date:.-
APPROSisD DISAPPROVED APPROVED SUBJECT To ABMM f
-Call For Reinsp.
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MEN TION N(YTI -
City �f Tigard Building rrns,ctannt
13125 SW pall Blvd. Tigard, Oregor, 97223
Insaection Line (Ret_-o-phone)s 639-4175 lusiness Phone: 639-4171
Inspect torte
Tooting Plbg. Underelab Mach. Rough-in Appr/sdwlk
rounJ. Plbg. Te- Out
Gas Line rIN a S
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Post/Bear Struct, San. Sewer. !raving -B)d
4•
Poet/Beam Mach, Rain Drain Insulation -Plumb.
Plbg. Underfloor water Line �'►
LOyp. Bd. '�eCh,
Date Requesteds_ 'As� 2'e) — _TLJ pX
Addresses
Builders
TIM 1OLLOWIN(i CORRECTIONS ARE REQUIRED:
TO
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Inspectors
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'.„ DISAPPROvRD
t. —'---APPROVED APVRO`JED 3UH,TECf TO ABOVE `
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P OVEMENT"/EXCAVATION /�`--' �' COPY TO.
APPLICATION - STREET IM R l A (WHITE)-FILE
ORDINANCE NO. 74-14 [Z (YELLOW)-INSP.
„ ''''77 (PINK)-OTHER AGENCY
(INSTRUCTIONS ON SEPARATE SHEET)
APPROVED � � (BLUE)-APPLICANT
-APPLICAI ION NO.: �—
_
NOT APPROVED 11CITY OI I IGARD, URE FEE AMT.: S 6'00 _
PENDING FEE. PMT. ❑ CITY HALL RECEIPT NO.: ----
I PENDING SECURITY ❑ PUr LIC WORKS DEPARTMENT BY-J.�l1= DATE_ 1� —
PENDING AGENCY ''OK" Cl AIyCI(,+tion and Progress Record MAINTENANCE BOND �
i PENDING INFORMATION O FOR STREET IMPROVEMENT/EXCAVATION AS RFUUIREU
ANNUAL L:
PENDING VARIANCE ❑ EXPIRATION DATE:
PERMITNO.. DATE ISSUED: BY:
1) APPLICATION APPLICATION IS HEREBY MADE TO EXCAVATE FCIR AND MTALL Widen an fjjjatjC>gDriveway-_ApC9n
- - _ - - AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
P. A. Sni�?�r Der3i r 1124? SE Highland GouL� Clac "
APPLICANT -- -_-- ' -..- `i _ �Xlw -`�-.I��_ ..U98_-Lfi8�—_ __ �
NAME AODRItff CITY PHONE
CONTRACTOR - _ _W*nC]�nL--._- - -- - - -
NAME ADDRESSCITU PHONE—
r City Staudarc?_s & S if icatiorlr.� -
PLANS B1' _____PQ NAME��J ADDIRK55 — CITV_ PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S 150.00 _
DOLLARS
OR OFFIC E: ;..MIN.
(2) EXCAVATION DATA: 0.04 x S � •� = S •�
STREETDESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATF'RIAL INSTALLFD ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM h QUANTITY
STREET
PEN .
Glacier Lilt �'ix cl (�t~e ttach 3) INSPEC-
TION
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ESTIMATED STREET OPENING DATE: —_—L_�_.—. —•- S
ESTIMATED STREET CLOSING DATE: E
(3) SECURITY NO. _.____ SECURITYANIT: S 150.00 ___ CLROSED
SURETY CO.: __ FINAL
CERTIFIED CHECK a CASH ❑ BOND iNSPEC. _
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS/CONDITIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT.
1 (A (See attached)L
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(5) NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMIS' ON TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAV JURISDICTI IN IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON.
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANV NJ' v OR,D/ MAGE WHICH MAY PESULT FROM APPLICANTS ACTIONS.
Z.,
APPLICANTSSIGNATURE - l i DATIF
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' O" MAX. 12C`- 0" MIN. 0
DRIVEWAY R/W LINE
_A_-4__I:� _
W ( CONTRACTION JOINT OPTIONAL
SIDEWALK
LOCATION
® SIDEWALK EXPANSION JOINT B
EXPANSION JOINT -`
CURB JOINT !
A
3'- 0" 8�-0" MIN. -0" MAX. .- 0" MIN.
FACE OF CURB
SIDEWALK ADJACENT TO CURB SIDEWALK AWAY FROM CURB
PLAN
1-1/2" EXPOSURE
c o USE EXISTING EXP;NSION
IC LEVAT ION B-8 JCANT OR SAWCUT ANG
PLpCE COLD JOINT.
SEE DWG, NO. CS-306. I
STREET fi
COkV%MD 3UBOAAM 2" OF 3/4" MINUS
SECTION A—A
NOTES ;
1. CONCRETE SHALL HAVE A MINIMUM BREAKING STRENGTH OF 3000 P.S.I.
AFTER 28 DAYS , 6 SACK NIX.
2. Cu.:d JOINT SHALL BE A TI-WELED JOINT WITH A MINIMUM 1/2" RADIUS
ALONG BACK OF CURB.
3. EXPANSION JOINTS SHALL F,!! 1/2" PREMOLDED ASPHALT IMPREGNATED
MATERIAL OR EQUAL , EXTENDING FROM SUBGRAOE TO FINISHED GRADE .
4, SEE DWG. Na CS-300 AND NO. CS-305.
WASHINGTON COUNTY
DEPARTMENT uF LAND USE RESIDENTIAL DRIVEWAY
AND TRANSPORTATION
DATECIVIL DRAY/ft APWA NO. � WA SK COUIN" Na
v « • -� AEA i►.os NONE DW- 200
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FACE OF CURB DRAINAGE BLOCKOUT
WIDTH OF STREET 3" I.D. PLASTIC PIPE
WITH COUPLING
I" R __ 6" —1/2" R
ROAD 40 •
II .
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MAx. -
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BASE COURSE •, I 1
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1• FOR DESIGN SPEEDS GREATER THAN 40 MPH THE EMERGENCY MOUNTABLE
CURB CS-300 SHALL BE USED.
i
2. COYCRETE TO HAVE A BREAKING STRENGTH OF 3000 P.S.L AFTER 28 DAYS. !
EXPANSION JOINTS .
A. TO BE PROVIDED ,
1) AT EACH PCiNT OF TANGENCY OF THE CURB .
2) AT EACH COLD JOINT .
3) AT EACH SIDE OF INLET STRUCTURES.
4) AT EACH END OF DRIVEWAYS .
5) AT LOCATIONS NECESSARY TO LIMIT SPACING TO 45 FEET .
B. MATERIAL TO BE PRE - MOLDED, ASPHALT IMPREGNATED, NON-EXTRUDING,
WITH A THICKNESS OF 1/2 INCH.
3 COIk TRACTION JOINTS .
A. SPACING TO BE NOT MOPE THAN 15 FEET .
B. THE DEPTH OF THE JOIVT SHALL BE AT LEAST I I/; INCHES .
4. BASE ROCK -?."-O OR3/41 1'4 , 95% COMPACTION. BASE ROCK SHALL BE TO
SUBGRADE OF STREET STRUCTURE OR 4" IN DEPTH , WHICHEVER IS GREATER .
5. DRAINAGE BLOCKOUT - 3" DIA. PLASTIC PIPE .
A. I.D. PLASTIC PIPE WITH COUPLING.
B. DRAINAGE ACCESS THROGH EXISTING CURBS SHALL BE CORE DRILLED OR CURB
SAW CU7 VERTICALLY 18' EACH SIDE OF DRAIM 9 REPOUREn 'i7 FULL DEPTH OF CURB.
-,.WASHINGTON COUNTY CURB NON - MOUNTABLE
DEPARTMENT OF LAND USE FOR USE ON MEDIANS
AND TRANSPORTATION
j DATE CIVIL ENGINEER DRAWN APWA NO. WASH. COUNTY NO.
y
ISS MOD.) CS- 301
- 92 - i
rt
R/W
5' MIN.--
CURB JOINT SEE NOTE 5 1
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2" OF 3/4"-0
-COMPACTED SUBGRADE
SIDEW \LK ADJACENT TO CURB
R/W
5 MIN. 6"
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2 %
ROAD
TSEE NOTE 5
Y
2" OF 3/4"-0
1� COMPACTED SUBGRADE
SIDEWALK AWAY FROM CURB
NOTES
I. CONCRETE SHALL BE 3000 P.S.I. AT 28 DAYS , 6 SACK MIX , SLUMP RANGE
OF I t/2' TO 3
2. PANELS TO BE S FEET LONG:
3. EXPANSION JOINTS TO BE PLACED AT SIDES OF DRIVEWAY APPROACHES ,
UTILITY VAULTS ,WHEELCHAIR RAMPS, 9 AT SPACING NOT TO EXCEED 45 FT.
4. FOR SIDEWALKS ADJACENT TO THE CURB 9 POURED AT THE SAME TIME AS THE
CURB, THE JOINT OETWEEN THEM SHALL B1_ A TROWELED JOINT WITH A MIN. 1/2"RADIUS, 1
5. S!DEWALK SHALL HAVE A M,NIMUM THICKNESS OF 6 !NCHES IF MOUNTABLE
CURB IS USED OR IF SIDEWALK IS INTENDED AS PORTION OF DRIVEWAY .
OTHERWISE SIDEWALK SHALL. HAVE A MINIMUM THICKNESS OF 4 INCHES .
6. DRAIN BLO CKOUTS IN CURBS SHALL BE EXTENDED TO BACK OF SIDEWALK WITH 3"DIA. PLASTIC
PIPE AT 2 % SI.OP�. CONTRACTION JOINT TO BE PLACED OVER PIPE.
,WASHINGTON COUNTY
-��DEPAF�TMENT OF LAND USE CONCRETE SIDEWALK
AND TRANSPORTATION
DATE CIVIL ENGINEERDRAw"
APWA NO• WASK COUNTY NQ
�T a NOME CS -- 305
- 25 -
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D 2rdCTION NOTICE
City of Tigard Building Department-
1,3125 811 Nall Blvd. Tigard, oratpn 97223
P
inspection Line (Rec-O-Phone): 639-4175 Business Phoney 639-4171
Znsper;t S.on a_
Frx)tiny Plbg. Underslab Mech. Rough--',i Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALa
Post/Beam Str_uct. San. Sewer 7raming _Bldg, d
Pont/seam Mach. Rain Drain Insulation -Plumb. j
Plbg. Underfloor. Nates Li.0 G
yp. B4) -Hoch. !
_ NO
Date Requested: i --Time: AM PM
3 Address: WSJ Permit #t-
Buildert
THE FOLLOWING CORRECTIONS ARE REQUIRM
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Inspector: Date:
�LAPPROVED DISAPPROVED _ APPROVED SUBJECT TO ABOVE
Call For Rsinap.
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INUPP-MON No1117&
City of Tigard Building Department.
13125 SA Sail aird. Tigard. Oregon 97223
Inepection Line ( -O-Phoneys 639.4175 Bubineas "'hones 639-4111
i Inspections �Nech. "
Rooting lbg. Onder.labfn Appr/Sdwlk
Round. y tY
Plbg. Top out da■ Line MALI
Post/Beam Struct. San. sourer °•;.
Framing -Bldg.
w. Poat/Beam Mach.
Rain Drain � naulatifun/1 _ply.
_.
Plbq. Underfloor Neter Lino pYp, Bd. �
.4 -Mach.
Bquate Reested: ��
Tues PH
Addraea,�
Permit f Z
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8u11dar:
LAC r'OLLOilINO CTIOMS AM RBWIRICDs
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In.pector: o
-- - Dates /-
L/"PPOVRD DISAPPROIrED
__ -- 11PPROVRb !•OBJ=CT TO 11HOVe
---Call For Reinap.
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SK&PE�'1'SON NOTICE
City of Tigard Building Departaant
13125 ear Ball Blvd. Tigard, Oregon 97223 41
Inspection Line (Rr-O-Phons)s 639-4175 Business Phones 63 J�f
Inspections�
Footing Plbg. Undsrslab Mesh. Rough-in Apex/Sdwl.k
Found. Plbg. Top aut Ons Line BINALt
r
Post/Beam Struct. Ban. Hewer �'F'r inq l�lfL,".( ` -Bldg. i
Post/Bsasi Mach. Rain Drain Insulation -Plumb.
PILL. Underfloor Nater Lina Gyp. Rd. -Mach, 10
lG l
Date Requestedi �j! ;_7 , Time: -AM -pm
Address e
Builder*
THT tOLIADWINO CORRECTIONS ARE REQUIREDS
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Inspectors Date:
-i----
rRQVED DISAPPROVED
_ APPROVED 8U&TELT TO ABOVE
Call For Reinsp.
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MNSPECTION HPT1-01
City of Tigard Bnllds-.:g Depart--".nt
13125 SW Hall Blvd. Tigard, Oregon 97223
Inepeation Line (Rec-O-Phon(-.): 639-4175 Business Phone: 639•-4171
d
Inspection:__— --------- ---- ----
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out gas Line FINAI•:
Poet/Beam Struct. Bart. Sewer Framing -Bldg.
Pust/Beam Mech. n Ura Insulation -Pl,mb.
Plbg. Underfloor Nater Line Gyp. Bd. -Mech.
Date Roquested: l,fir 10 1. Timet AM ru
Address: Permit #t
Builder: �— clu - +r
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector f � `--- -- Date:-
-APPROVED — DISAP"ROVEI, APPROVED SUBJECT TO ABOVE
Call For Reinap.
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INSPECTION NOTICE
City of Tigard Building Depax-twient
13125 Sit Hall Blvd. Tigard, Orogon 97273
j Inspection Line (Rec-O-Phone)s 639-4175 Business Phonp: 639-4171
Inspection:
i Footing Plbg. 'indorelab Mech. Rough-in Appr/Sdwlk
Fo:� Plbj. Top Out Gas Line FINAL:
M
Post/Beam Struct. Pan. Sewer Framing -Bldg.
' Post/Beam Nech. Rain Dra4n Insulation -Plumb.
Plbq. Underfloor Water Line Gyp. Bd -Nech. A
f Date Requested: L C Time: AN _ _PM
4
tAddress: (�, / S 2 //Permit #: G
5
THE FOLLOWING OORRECfIONS ARE REQUIRED:
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Insper_t
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APPROVED DI9APPROVEb APPROVED EIJBJECT 4'O ABOVE
—Call rot Reinsp.
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CITYOFTIVARD CITYOFTWARI) a ,
'COMMUNITY DEVELOPMENT DEPARTMENT oenooN MOS EFS p LRMI (
1-'Lf�MI T #. . � . , . .
13126 SW HWI Blvd. P.O.Box 23377,TiPM,Or*Pn 07221(603)6344176
c;.iT 1x 54,5 6W (:`LAC'IE.fR LILY LIR PA{ UY-L: iSl3.`1)A..4A3700
SUDD•I V I a I ON. . . . : AMART SUMME RLAKE:: ZONING. R-7
BLOCI.. . . . . . . . . . . LOT. . . . . . . . . . . . .
------ ._.__.... BUILDING _.__._.__•_._...._.___.__._._.._._..._._____._.....__.....____..__....
REISSUE.s DWELLING UNITS:0 BASEMENT. . . . . . . . :0 Sf
CLASS OF WORK. c ADD BLDRMS a 0 1.%A AT t C, GARAGE.. . . . . . . . . . :264 5 f
'I YPE OF uF3E. . . ISS F"LtJOR f?LUUIRED 0[. T8AC:KS ...-.__ ._. _.........._
+ TYPE LCONST. :5N FIRST. . . . -72 sf LEFT. . : 14 rt RIGHT. 14 ft
0GC.UF4-,N(.'Y CaRP. : R2 SECOND. . . :VI 5 t F idJN i. :; 1ji t t RE:f R. . : 15 ('t �
IS TOR I ES. . . . . . . .. 1 7!-1 i RD. . . . s f' RLUU I RED•_._.. .___.._.. __.._.. ._. ..__._.__ s
HE 161 i1". . . . . . . . : 16 ft TOTAL SMOKE DETLCTUFS. :
h•LOOR LOAD. . . . .40 p s f VALUE. . . . . $1 8064 PARK I NG SPALEri. . .0 �
Remarks : I'fal-l-i I NEED STRUT OPE-M.140 PERMIT
PLUMBING - --._...__ ._._.__._.._,.._...____._.___...•__..___._.__.•......_ ._
LINKS. , . . . . . . . . .0 FLOOR DRAINS. . . . . 0 E)ACKFI-OW PREVNTRS. . c0
LAVATORIEw. WATER HEATERS. . . -0 TRAPG. . . . . . . . . . . . . . :0
•T•UB/5i-OWLRs. . . . :0 LAUNDRY `1'Rf�Y'Z: . . , : I CATCH 13AGIN:S. . . . . . . ...0
WATE17 CLOSETS. . -.0 SEWER LINE (f t) . :0 GREASE TRAPS. . . . . . . c 0
D I SHWASHERS. . . . :0 WATER LINE ( ft ) . c 0 OTHER FIX 1 ;IREG. . . . . ..0
LHRBAGE: DISP. . :0 RAIN DRAIN (ft) . :0
WASHING P'IPCH. , ; 1 SF RAIN I)RH I NS. . -.0
__. ...._.._._._..__.._..____ MECHANICAL. _____....__ _... ._._ r_.__.__. _... ._ ..,._.___._...._.__- FLE ''S;
FUEL TYPI•WwUNIT HT PS. . :0 type amount. !ay bate rec.pt �7
/13RB/ i ✓ VENTS . . . . . :0 F1P1._4_r $ 74. 50 JH 0:3/E6/9.3
`! MAX INPUT :0 BTU VEN"p FANS. . : 1 BPLC: $ 48. 43 JL.H 03/ 11/93 93--2'37714
FURN { 1910K . . :0 HOODS. . . . . . ..0 E.►5PC: $ 3. 73 JH 0.3/26/93 -
f-'URDJ > 10111E , . :0 4JClUDSTOVE5. :0 !APRT # t'5. 00 JH 03/26/91:; -
FLUOR TURN. . . . -0 C:;LCI DRYERS. : .1 MPLG $ 6. 25 JH 03/eEk/9.i
BOIL/CMF' < 31IPc0 OTHER UNI'TSUO WI! PC $ 1. LZ JH 03/26/93 ._.
GAS OUTLETS: 1 PPRT $ 25. 00 JH 03/26/93
Ownev, : __.__.___.._._._._.._...... __...._._..._.._..__.,I',E,C $ 1. 115 JH 0:31e_61()a
KEITH MUCLURE
li•:545 SW GLACIER LILY CIRCLE.
T IGARD OR 97a23
Phone ##:
Contractor: _._.___.__._....._._._____. ____...._ ...__........_.. ::1
1 , A,, SNIDER DESIGN
11247 Sir HIGHLAND LOO
CC.40.111nmAS OR 9,7015
Phune %3 698-•6680
Rey #. . : 52341
A
18t-1. 41 TOTWL
This perrit is issued subject to vie reoulations rontaired in the - - REQUIRED INSPECTIONS - -
Tigard Municipal Code, State of Ore. Specialty ,-•,,as and all other Foot/found Insp Gas Line Insp
applicable laws. Ali worw will be done it ! with approved Pust/Beam :Str1m-.t In at.ilatiun Insp
plans. This pereit will expire if war in 180 Post/beam Mechan Gyp Board Insp
nays of issuance, or if work is susptr,( days. F='LM/Underfloor Rain drain Insp
IvIpchaniLai Insp Water Lint. Insp
i,e r,m i t '; e e b i.y n a.t i.(r e — _. P 1'_1 o1 b 'Fop O'.(t Mechanic..ra l F i n al l
Framing lnsp F'1+.imth Final
py ° F irep(Iace Insp NcIilding f"ir,ai
C:aI i for ;71 ecl; iun - 639 417,e
' s
F
C�C
CITY OF" T I GARD RECEIPT OF FIAYMFNT RFCE I VIT NO.
CHECK AMOUNT a 1:36. 98
NAME T. A. UNI DER DESIGN CASH AMOUNT a 0. 00 � rr
fal)1)Rf Ci a PAYMENT DATE a 03/26/93
UBDIVISION a
PURPOSE OF; PAYMENT AMOUNT PAID PURPOSE: OF PAYMENT AMOUNT PAI0
H JIUD•ING PERM _ 74. 50 PUUMBINO PERM _ __,... . _2 . 00
ME'C;HANIC:AL FSE 25. 00 ST. PUIL.D PER 6. 83
FLAN CHECK FES 6. 25
a
1 . 345 SW GLACIER LILY CIRCLE ti
rOTAL AMOUNT PAID -- —> t36. `?R s
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:moi - .. _. a���,..c;a;,,...,».«:«....,1+.�.......,.....».,....,..-,H. w........�wew«.w.,v...�.,...,...x.n..-w..r.er,v, +,........, _.._.,.. .... _._ .....
C JL
1 1, OF �1 �� 13125 sw tt,a Bhki PLNCK/RECT ..�
PERMIT 0
COMMUNM DEVELOPMENT DEPARTMENT T Id.0-9°"97M
(M)43"171
DATE ISSUED
JOB ADDRESS: IZ545SW.Gu�uE2-Lw4C, m4L-E TAX MAP/LOT s3 nq ~ 037oU
SUB: ` Q W"V , ;uLL NY-Z LOT: LAND USE:
f
VALUATION: D
I
OWNER SFECIAL NOTES
NAME: kLN �'�� Cc-VR-E REISSUE OF:
ADDRESS: S4JS S1tV 6LjXCAEF- 1-1 Lrz LAST REISSUE:
FLOOD PLAIN/
PHONE: �Z-LI '`)�Zr7 _ SENSITIVE LAND:
i
,r 1
ONTRACTOR �CJ APPROVALS R QU I RCD
NAME: ' . t-\ • *)9%DER- 'be SICLkA PLANNING:
ADDRESS: 11 2AI lAY .1 uAt-A Loop ENGINEERING: _
CL S 0(L c)-7 _ FIRE DEPT:
PHONE: CpgJ3- (e ave Q - OTHER:
CONTR. BOARD #: 52-541 EXP DATL:
1LU -(o - 2, ITEMS REQUIRED 1
SUBCONIP',CTORS: PLUMB: 4 W:,H AWAAWC'A1C._ �9C,• LIST/SUBCONTRACTORS: — -
MECH: 0 u3m N (-Ow\f 011-V �t03 lAk BUS I AX: _ !
ARCH/ENGINEER CALCULATIONS: _
NAME: TRUSS�ESIG.PI TRUSS DETAILS:
ADDRESS: I IZ4SE ,14 ioA1Aok Loor _ OT"ER: _
(—osC�A VA&s 0 V �-lo
PHONE: --- �D9,9.=(96K) _
PROPOSED BLDG. USE: _ LPQV4or- G4�1-FLAG
COMMENTS: .1 Z
-55
APPLICANT SIGNATURE
Received By: _ _ _ Date Received:
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE" I! \
Asfy3-o G 10-432 00 Building Permit Fees
O
10-431 '00 Plumbin Permit Fees
10-431 01 Mechanical Permit Fees 2_
10-230 01 State Building Tax (5x) (•z' --
Building .3. 73
Plumbing /• 'I�
Mechanical Z . 1 >
5
Z
10-433 00 Plans Check Fee �
Building 41k. q_3 ✓'
Plumbing
i
� Mechanical �'•L jr�'
10-230 06 Fire _ —
30-202 00 Sewer Connection
33-444 00 Sewer Inspection
25-448-02 Commercial TIF Fees
25-448-04 Industrial TIF Fees _
25-418-06 Institutional TIF Fees
;i 25-448-03 Office TIF Fees
25-448-01 Residential Traffic fees
25-448-05 Mass Transit TIF Fees _
52-449 00 Parks System Dev Charge (POC) _
31-450 00 Storm Drainage Syst Dev Chrg
I
(SSDC)
24-445-01 Water Quality (Fee in lieu of)
24-445-U2 Water Quantity (Fee in lieu of)
'3
TOTAL_ /�5, �,. ? r' 9
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1
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nm/3587P.WPF
1
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CITY (IF 'T 1 UA RLQ REGE 1 PT NP.t. 714 t
lAE('K AMI�IUWT a 46. 43 I
NAME x T. O. SNIDER CASH AMOUNT a Q). 00 � �►
ODDR.E SS t PAYMEW DATE', 0.-4,111
SLIM TVPTT ON o
WRC OSE UFFSA'/OWNT AMOUN'P PA i D PURE-101-iC OF PAYM;—N I' fih1UUN'i I:'i i 1 Ll
U
1;2545 SW GLACIER LTLY
111"MIL AMC,LIN'I PAID _. ._ ... 46. 4 �
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