9982 SW JOHNSON STREET FILE NO. 'q9--17
JOHNSON ST. - 9982 STR. OPN. PERMIT
APPLICATION - STRUT IMPP 'EMENT/EXCAVATION COPY TU:
L] WHITE) FIE
ORDIN-ACE NO, 74-14 L] (SLUE) -INSP.
(INS"RUCTIONS ON SEPARATE SHEET) ❑ ('BELLOW) -OTHER AGENC,
rl (PINK) APPLICANT'
AI•PROVED x, I APPLICATION NO.: ��,_�__._._—__
NOT APPROVED L CITY OF TIGARD, OREGON FEE AMI.: 16
PENDING FEE PMT. ❑ CITY HALL. RECEIPT NO.:
PENDING SECURITY ❑ PUSL/C WORKS DEPA R TMEN T BY - r _ DATE-__ __�/�^f!-�_
PENDING AGENCY ''OK" E] Xpplication and Progress Record _ — — —
.NDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION MAR ASEREAQUIEDBONp,� _
ANNUAL ��❑
PENDING VARIANCE ❑ EXPIRATION DATE: /
J PERMI f NO.: _ =Z7__- DATE ISSUED: 1��rL_Z_�_ , 3Y: --a1�J ,_
(' } APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL -- - ._:,-li C.__
AS DESCRIBED HEREIN, IN FULL ACCORpANCE WITH CITY REQUIREMENTS.
APPLICANT -EI: 1``� [aC ! ['J /c�U� �3.-�1
NAME ADDRESS CITU • ONE
CONTRACTOR__�l..�v► -Q
��f�A ISE --A-DURESS CITY ---------'PHONE
--
PL_ANS BY /4 -
NAME ADURESS CITY _pH PNE ._
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ —
_ _ DOLLARS
FOR OFFICE USE: wT --- a+-=i'MIN.
(2) EXCAVATION DATA: / G _ _ 0.0
2
x S_
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLEb )TEM DATE ►[! MARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM ale QUANTITY
_ / -- STREET
p
IN91-i -
---- i R TION
E — --
Q
ESTIMATED STPEET OPENING BATE: / E
ESTIMATED STREET CLOSING DATE: 7 T '—
_ E
D — -- ——
(3} SECURITY NO. STREET
—
CC�ITY AMT.: $— CLOSE
SURELY CO.: — r_ a FINAL
CERTIFIED CHECK ❑ CASH ❑ BOND INSPEC.
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL _ SPECIAL PROVISIOP S / COIInITIONS
FEATURES: EXCAVATION LOCATION AND EXTENT.
1
I I h 1 1
.:'5—
(5) NOI: THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT ur-WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON,
THE AP"LICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL rIERTINENT LAWS AND
CON5TRUCTION SPECIFIC ATIONS PERTINENT TO CONCOCT OF 'THE WORK, AND TO SAVF HARMLESS THE CITY AND
EMPLOYEES AGAINgT ANN INJURY OR DAMAGE WHICH MAY RESULT FROM AI°PI_ICANTS ACTIONS.
i
APPLICANTS SIGNATURE: DATE.
t
1 '
Date 3 - S -7 7 Amount $
Name Cash
..
M.O.
Address—/d y S V e C, check
Bldg. St.Opng. Bus.lit.
P 16 Pu6ctns. - E] B;ke lit.
Flrtl. Copies Sew.Serv. - lI
Se Mer Filing 7� Fine&F.
Assmi. Other Zoning
for: C
Permil -----
CITY OF TlG`ARC+
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15215