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10399 SW NORTH DAKOTA STREET { 1229HIS tlS, AVCI H,IHON MS 66£OT .Z` 24 * �b41,�s�y' r^• ht« � ' ,'Rb tp� dew. +�,� 1r� ,.b��1tt. ,p� t�w'�TM"�'"!''W��Y. ` ,yd rq?yt�M,rs�',��y 'I�t f��.j'�„"*, ^;.��{•���' �m"�`'asttie `.¢l�Ir; ��J/I �,ta,`,M 1 �,Mw' 'y, ��.�JI�.,'Wl�.J�IJ� '��"'�'`"r„ � �'P'� .I�NM"•„�y~ �'� ,:p t�;l�` , p ���' 1�,��'6►► � �,�fiL�„f•��,�� +.���:•'�,, ���i�,,, '�p f��I �;”—',. ��"'�'� � I r,,�p�,-"1j4.,� T \� •,r'. dt'� ►' ,c. (� ,i'� •>:tv Gl/,y�� .ti,. _ ,�e •s►, �+ �',"� e'd ,�' .�`,ear . +.....•.'_::y... ^^.^'^."Tq' tq\111•J{{gyp _—. ..__ .mamaraaaarr n±�---^e�qv-�r ^'- r '�7 1 J 1 r ` 3 ,. 00 00 10 IT 0 to 04 CIS pOD Of�y cflIgo 0 44 00 1 ! 1 v �r s o � li r� 9Jy v o z o ad , '�►c. Q, p m Ns kxv � ori o tt! ��e� y mi�mtr:�cfir+acwv` �ism• ti6o7itlrhutro�A��,� -�.�ac�u c ��T� . :.,... J .�'_niar.�i, ,�,i�,,,_;____ 'i � ��Y jr:�llJJ\ .. I•�dV�.t�'� �� `4.4� 11�• l < '� w +off �y��,"' °,��•, . .., �, Una �.. INSPECTION NOTICE City of Tigard Building Department P O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested c Z� Time A.M. P.M. Address 3 / / it �� Permit #_ --- Owner Lot # _ Builder The following Building Code deficiencies are required to be corrected: l Presented to _ I�1Approved Inspector d ( I Disapproved Date CALL FOR REINSPECTION CJ YEI 0 No BUILDING PERMIT CITY OF T'FA RD PERMIT NO. : BU870004 CITY OFTWARD COMMUNITY DEVELOPMENT DEPARTMENT MOON 13121,S.W.Hall Blvd.P.O.Box 23397.Tigard.Oregon 97223,(503)6394175 DATE ISSUEDi I J /25/8"17 --------1---E81M-PMT.NQ. 970004 PR4.� f 7 JOB ADDRESS 10399 SM NORTH DAff.'OTA ST TAX MAP/LOT I S 1---1 4 DA I 0t) SUB 2 I-Tt 8V LAND USES R I A% LOT STZEll '.)ALUATION: $ 216. 1213 SETBACkS FRONTit REARS WOR11: CLASSIt NEW DWELL.UNITSo a LEFTs RIGHTI; USE TYPE: 5+ FAMILY NO. BEDROOMSo ib EXT.WALL CONSTs CONST. TYPE: ',IN NO.BATHSs 16 1*41 So Elf 141 OCCUP.OPP. -. P1 PROT.OPE N I N13S i OCCUP.LOA1, Ni St Elf Wit TOTAL AREAS '7408 NO. SIDRIES: 2 ISTe 3704 ROOF CONSTs A FIFE PET '' iES HE IGHT: 22 2ND 1 3704 AREA SEPAR,7 YES RATED 2 Ht,- BASEMENT" NO OCCUP.SEPAR-' NO PATEDII MEZZANINE7' NOI BASEM"T FLOOR LOADI: 40 GARAGE i F IRE SPRKLR7! ALARM:' HO F L OW(GPM II DETECT-' YES uc IN.'T 4 VAR&I &I 161L wnt,p ACC,r%rjm �,Cj F'LlC-41 CHECK S1, s bcr REMAK S i building #4 REISSUE OF PIO. LAST PE'ISSUE 0 Fr=ES1 W (;4%-?'1-tLtM P°�- -,)Pf%t-tj0* F LRM I T X17'"'5.51-i N E 111 s w 05th PLAN REVIEW $471 . 58 R portlend or 97204 FIPE DEPT STATE TAX 1111136. 28 OTHEP C DEVELOPMENT CHARGESI 0 N SDC(STORM) R T SDC (STREET) 191130.00 A PDC (#1 11 C PPEPA[D $761 . 18 T 0 I R I TOTALlf tb4, "161 . 77 This permit is issued Subject to the regulations contained in Title 14 RECEIPT NO. --4-7600 of the TMC. State of Oregon Specialty Codes,zoning regulations and all other h, plicable codes and ordinances. and it is hereby REQUIRED INSPECTIONS agreed that the work wl':be done in accordance with the plans and FOOT I NO SEWER specifications and in compliance with all applicable codes and FOUNDATION WALL PAIN DRAINS ordinances The issuance of this permit does not waive restrictive covenants Contractor and subcontractors shall have Current city POST & SEAM WATER LINE business tax permits This permit will expire and become null and PLS.UNDERSLAP CITY APPPCH'SW void if work is not started within 180 days,or If work is suspended or SLAB FINAL abandoned for a period of 180 days any time after work has PLB. TOPOUT commenced, It shall be the responsibility of the permittee to assure all required Inspections are requested and approved FRAMING FI PEPLACE GAS LINE I NSULAT I ON Permitter, Signatur.e SYP. BOARD Issued By CALL FOR INSPECTION 67P "It ' SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE CITY®F T167ARDSEWER PERMIT CrIYOFTIORD PERMIT NO. : SE870009 COMMUNITY DEVELOPMENT DEPARTMENT 13125 S.W.HP11 Blvd.,P O.Box 23397,Tigard.Oregon 97223.(503)639A175 DATE ISSUE Di 11/25/87 PRIM. PMT.NO. 870 JOB ADDRESSe 10399 SW NORTH DAKOTA ST USA NUMBER: TAX MAP/LOT IS134DAloO SUBit LT: LAND USE: R12 LOT SIZE: SECTION: 34 TWPII s RNG: w WORK CLASS: NEW USE TYPE: 5+ FAMILY The applicant agrees to comply with all rUlelig and regulations of the Unified ,;ewei­a(;e Agency. The permit expires 12() days from the date i5q;Ued. The total aMOLint paid will be forfeited if the permit P�:pires. The Agency does not guar- antee the aCCLlraCY of the location of the side sewer laterals. if the Sewer is not located at the measurement given, the installer shall prospect '171 feet in all. directions from the distance given. if not so located, the installer shall PUrchase a "Tap and Side Sewer" Permit and the Agency will install P lateral . INSTALL. TYPEt BUILDING SEWER IMPERVIOUS AREA: FIXTURE UNITS: TENANT IMPROVEMENT: DWELLING UNITS: 8 0 W FEES: N SpeCtUm Propei-f -ies PERMIT $45. (10 E R III s w 5th CONNECTION CHARGE $0,(300. (10 portland nt 97F2( 4- LINE TAP INSTALL. . (Sup") C OTHER 0 N T R A C T 0 R t TOTAL..: $8, 845. This permit Is issued subject to the regulations contained in Title 14 RECEIP-" NO, of the TMC. State of Oregon Specialty Codes.zoning regulations and all other applicable codes and ordinances, and it is hereby agreed that the work will be done in accordance with the plans and REQUIRED INSPECTIONS specifications and in compliance with all applicable codes and ROUGH-IN ordinances. The issuance of this permit does not waive restrictive covenants. Contractor and subcontractors shall have current city business tax permits. This permit will expire and become null and void if work is not started within 180 days,or if work is suspended or ahandoned for a period of 180 days any time after work has commenced. It shall be the responsibility of the permittee to assure all required inspections are requested and approved. I(/Permittee Signature Issued By: CALL FOR INSPECT ION 67'9-41751 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE /2- ,y- 87 �2 PLUMBING PERMIT PERMIT NO. : PL870029 CORl6ON C17YOF TIGARD "COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUEDt I I/25.,,6771312�,S W Hall Blvd-P 0.Box 23397.Tigard.Oregon 97223,(503)639-4175 __ PRIM.EMT.NO. 870004 _rOB ADDRESSi 10399 SW NORTH DAP."OTA ST TAX MAP/LOT I S I 34DA 100 SUBI LTi 9F- ll LAND USE% R12 LOT SJZEs ITEMi NO: NO- WORE( CLASSo NEW WATEP CLOSET' 16 TRAP USE TYPE 5+ FAMILY URINAL BKFI_OW PRVNTP CONST. TYPEt VN LAVORATORY 16 TRAP PRIMER OCCUP. GRP. t RI TUB SHOWER 16 GREASE TRAPS DISHWASHER 8 GARBAGE DISPOSAL 8 NO.STORIES% 11) .4. WASHING MACHINE 8 DWELL.UNITSo 9 LAUNDRY TRAY BLDG. DRAIN (DIA FLOOR DRAIN SINK 8 SEWER (FT) 100 WATER HEATER 8 STORM/RAIN (FT 100 OTHEP REMARt1:'.9 i building #4 0 FEES: W Spectum Properties PERMIT $740. 00 N E III s w 5th R portland or 972c:14 1 FIXTURES 3 STATE TAX $37.00 OTHER C 0 N T R A C T 0 R TOTAL: $777.00 This permit is Issued subject to the regulations contained in Title 14 RECEIPT NO. of the TMC, State of Oregon Specialty Codes.zoning regulations and all other applicable codes and ordinances, and it is hereby REQUIRED INSPECTIONS agreed that the work will be done in accordance with the plans and PLP.UNDERSLAB specifications and In compliance with all applicable codes and POST & BEAM ordinant.ds. ,he issuance of this permit does not waive restrictive WATER LINE covenants. Contractor and subcontractors shall have current city business tax permits. This permit will expire and become null and PLB. TOPOUT void if work Is not started within 180 days,or If wurk is suspended or RAIN DRAINS abandoned for a period of 180 days any time after work has F I NAL commenced It shall be the responsibility of the permittee to assure all required inspections are requested wid appri,ved. Pol 11)01(;S�Ignature 1­,twd f3v lkl t_ CALL FOR I NSPECTI ON, 6.7,,q-4175 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE AW4KW-MmINdirlL C11YOFTIGrARD _ MECHANICAL PERMIT „� PERMIT N0. s ME870034 COMMUNITY DEVELOPMENT DEPARTMENT clrvoFn�,aRc ORfOON 13125 S.W.Hall Blvd.,P.O.Box 23397,Tigard,Oregon 97223,15031639-4175 PAI H"(1 H T LIND R ,. s r-t 0-1-�-r-r- — — -------- _ TAX MAP/LOT 1S13:4DA100 SOD: LAND USES R1 LT: LOT SIZES I TEMs WORK CLASSI NEW FURNACE <100kNOI USE TYPES 5+ FAMILY AIR HANUL.R <10 CC1NS'T, TYF E e VN FURNACE 10%-'+ AIR HANDLR 1 OK 13CCUP, GRP. I R1 FLOOR FURNACE EVAP.COOLER HEATER VENT FAN VENT :24 VENT. SYSTEM NO.STORIESs I BLR/COMP 3HP HOOD LR/COMP .'.+ 15HP DWELL. UNIT', 8 PL_R/COMP 15-�C►HF INCINERATOR (DOM FUEL TYPE ELEC. INCINERATOR(COM MAX.. I NPUT BLR/COMP ''>0-50HP REPAIR UNITS FIRE DMPRS'? PLR/COMP 50+HP OTHEr; HIGH PRESS'? GAS PIPING OUTLETS LOW FRESS''- b0ilding #4 SPel: tum Pf-oppr,ties PERMIT -- 111 s W 5th N PLAN REVIEW N portlaind or 97 (;14 $29. 50 F 5t-tom FIXTURES STATE TAX $108.00 OTHER $5. 90 0 N T R A C T O R TOTAL; $). ? REC'E'IPT NO. 7o c This permit Is issued subject to the regulations contained in Title 14 of the TMC, State of Oregon specialty Codes,zoning regulations REQUIRED INSPECT 1©n!S and all other applicable codes and ordinances, and it is hereby ROUGH-IN N agreed that the work will be done in accordance with the plans and specifications and in compliance with all applicable codes and ordinances. The issuance of this permit does not waive restrictive covenants. Contractor and subcontractors shall have current city business tax permits. This permit will expire and become null and void if work is not started within 180 days,or if work is suspended or abandoned for a period of 180 days any time after work has commenced. It shall be the responsibility of the permittee to assure all required inspections are requested and approved. Prnith,,, `ivanalure lsstwrl i1- _ _ CALL FOR INSPECTION 639-4175 SEPARATE ERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE CITY OF TV- ARD November 20, 1987 OREGON j Mr. rharles Harris Spectrum Properties 1.11 SW Fifth #850 Portland, OR 97204 RE: Apartments 11103-91 SW North Dakota Street Dear Mr. Harris: The detail for the two-hour area separation wall to be utilized in the above referenced project is approved with the following conditions: 1. Two layers of 5/8" type "X" gypsum wallboard shall be applied to the face of the truss 5 feet .from the two-hour wall. 2. There shall be no openings within the Prea between the two-hour wall and the one-hour construction at 5 feet away (this includes eave and roo` vents) . However, the area does require ventilation and a suggested method to achieve ventilation and fire protection would be the installation of fire dampers through the one-hour protected truss (one at the top of the truss, one at the bottom) . 3. There shall be no unprotected openings through the one hour ceiling protection. If you have any questions, please call 639-4171. Sincerely, Brad Roast Building Official cn/1944D 13125 SW I-lall Blvd..P.O.Box 23397,Tigard,Oregon 97223 (503)639-4171 - - GNUIL_DINCS P&M:T C11Y OF TIVAND PERMIT NCI. a ETU8701C►1 �w1� 7 cmoaAcro DATE I SSUED e 1 I/tb i 87 COMMUNITY DEVELOPMENT DEPARTMENT PRIM.PMT.NO. 870004 13125 S.W.Hall Blvd..P.O.Box 23397.Tigard.Oregon 97227.(503)639.4175 t_lH ADDRF.:SSe 11179SW NORTH DAKOTA ST TAS( MAP e LUT 1 S 13 4DA 100 SUE t L T t 8K : LAND USE.e R12 LC' S I ZE e VALUAT I ONt SETBACKS FRONT l: REARt WORK' CLASSt NEW DWELL.UNITSe 8 LEFTr RIGHTe USE TYPEe g+ FAMILY NO. HEDROOMSt t6 EXT.WALL CONST: CONST.TYPEII VN NO.BATHSt 16 No Se Es bl: OCCtJP. (3PP. t R1 PROT.OPENINGSt OCCUP.LDAL) Ne Se E:'t Wt TOTAL AREA t 740113 NO. STORIESe 2 1S'Tt 7,7014 ROOF CONSTt A FIRE RET? YES HEI©HTe 22 2NL"►t 37014 AREA SEPAR? YES PATEDt 2 HP PASE;ME:NT? Np ''RDI OCCUP ,SEPAR7' NO RATEDt MEZZANINE? NO EIASEM'T FLOOR LOADe 40 OARAGEe FIRE SPRK;LR'? NO ALARMNO FLOW i 6PM) DETECT YE:=- HEAT T YF'E e ELECT. HDCP.ACCESS? NO CORR'' NO t cr PEMARP S e bt.li ldtnq 04 REISSUE: OF NO. foundation can) LAST PES 1 SSUE —7 �E:ESe 9poc tum Prop�rt l wtt PERMIT #�C►' t:►C1 W III 1e w 5th PLAN REVIEW N Portland of- 97204 FIRE: DEPT R rho*; STATE TAY #s^•!501 OTHER ------....____-- DEVELOPMENT CHAR©E9t SDC (STORM) SDC(STPEE:T) N PDC (M1 1 R PREPAID A C R RECEIPT NO.� This permit is issued subject to the regulations contained in Title 14 PEQU I r,ED INSPECTIONS of the TMC, State of Oregon Specialty Codes, zoning regulations and all other applicable codes and ordinances, and it is hereby FOO t INCA agreed that the work vi� II be done in accordance with the plans and specifications and in compliance with all applicable codes and ordinances The issuance of this permit does not waive restrictive covenants Contractor and subcontractors shall have current city business tax permits This permit will expire and become null and void it work is not started within 180 days,or it work is suspended or abandoned for a period of 180 days any time after work has commenced It shall be the responsibility of the permittee to assure all req d Inspections are requested and approved Permittee Signature Issued By CALL FUP INSPECTION 639-4175 - —� .. SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE I T 1.T"t=: f'F'F�M r eJE Ti�,�4RD ��><, F I-* F 1 T' NO. 1 CITYOFTWAltD COMMUNITY DEVELOPMENT DEPARTMENT 13125 S.W.Hall Blvd.,P.O.Box 23397,Tigard,Oregon 97223,(503)639-4175 NORTH DAPOIA ST (11AP/t OT IS I '74DA I(Iii) 'SUFI 1 lir, I "F JAI 0 l- 1 i.l 1 e F, VAL UE E S ("PAP I N13 :'s [ ANf)F%(--e4F,1NS711 YES 51 IFF PPFF'APATT0N",'Jl F N 'Ploc turn proriprt F-'( WA PFV f FW 45 TA'k C 01 HFR 0 N T A C T 0 128.oa This permit is issued subject to the regulations contained in Title 14 and all other applicable codes and ordinances. and it Is hereby JUIPED INFPECTICINS of the TMC. State of Oregon Specialty Codes,zoning regulations PFIF, agreed that the work will be done in accordance with the Plans and specifications and in compliance with all applicable codes and U)PAIN ordinances. The issuance of this permit does not waive restrictive L I NE covenants. Contractor and subcontractors shall have current city business tax permits. This permit will expire and become null and void If work Is not started within 180 days,or if work is suspended or abandoned for a period of 180 days any time after work has commenced It shall be the responsibility of the Permittee to assure all required inspections are requested and approved 'permittee Signature Issued By 4 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE L -r o L4 0 5-3 ► -TT I CITY OF TIFARD No. 261173 I 13125 S.W. HALL BLVD. P.O BOX 23397 l� TIGARD,OR 97223 Date i I Name I Address Lot Block/MsionlAddreas Permit ft's Bldg. Plumb Cash Check JIM-f-LIL I/ Other Other Rec. By ,/ I J . f I Acct. No. Description Amount i 10.432 _Building Permit Fees _ 3,40 10.431.600 PlumblnR_PermIt Fees 10-43_1-601 _Mpwi.:,ni- x Permit Fees _ 10.230.50_1_ Statt,• 13LO(j_.Tax 10.433 _ Ph-os Chec! Fee 30.443 Sewcl Connection 3U-444Sewer Inspection 51.448 _ Street Syst. Dev. Charge 52.449.610 Parks I Syel. Dev, Charge 52 449 620 Parks II Sysi. D_ev. Charge 31.450 Storm Drainage Syst. Dev. Charge 10.430 Business Tax 10.434 Alarm Permit_ i�- 10.227 Ball 10.455- Fines _TrafficlMisdfParking 10.230- CPTA TrafficlMisdlVlc. Asst. _ 10-456 _ Indigent Defense _ 30.122.401 Sewer ServlcelUSA — 30.122-402 Sewer Service/City 30% 30.123 Sewer SevicelClty Maint. 03�125— Unmatched — `-- 31.124 Storm Drainage 4 •4 5anccroftPrin. Pymt. 40-471 ancro t Int. Pymt. — TOTAL i '� ®s =MAW-0 PLAN CHECK APPLICATION PLAN CHECK I PERMIT / DATE ISSUED .JOB ADDRESS: :,�/ > '� �� off' ;N� .jc r 'r.4117Ax raP/LOTS SUBS T= — LAND USE: ,,ez_ ` VALUATION: 1.2 SETBACKS: FRONTS _ RE : LEFT: RIGHT: 2 TOTAL AREA USEWORTYPE: HEIGHT: :ZARCLASS: �% FLOOR LOAD: Yo_ 1ST: -�0 USE /�-�;,�r1 CONSTR TYPE: s-,.i HEAT TYPE: f=- 2ND: 3 _ OCCUP GROUP: _ DWELL/UNITS: P3RD: OCCUP LOAD: _ NO BEDROOMS:/r BASEMENT: NO STORIES: Z NO BATHS: z 9� GARAGE.: IMP SURFACE: _ I APPROVALS REWD SPECIAL NOTES ITEMS REQUIRED PLANNING: ti REISSUE OF: LIST SUBCONTRACTORS: _ A ENGINEERING: LAST REISSUE: BUS TAX: FIRE DEPT. : ~ti' FLOOD PLAIN/ CALCULATIONS: OTHER: SEN LND.: TRUSS DETAILS: PARKING PLAN,: _ LANDSCAPE PLAN: PLAN CHECK BT: OTHER: COt6itlRllTS -DEMIPTION Gum 10-432 Building Permit Fees !_ '%t _ NA)mI 10-431-600 Plumbing Permit lees ADDRESS: ��;_ ;F ,���-,11U-431-601 Nee%anical Permit Fees - ��---y�� 10-230-501 Ste'ke Building Tex (51) ^9 ! 10-433 Plans Check Fee PHONE:� =,va cEs 4. ..:30--443 9 er Connection (20x) i 30~202 Seger Connection (80%) ":- ! 7 4 0 30-444 SewNtr lnBpeaition - ! nA*440 4ttiet totes Derr. Charge ON) !� egg= '$1449-•610 Wks 2 systems Day. Charge (PDC) ! z a 52-449-620 PtrkajI System Dev. Charge 31-450 Ston Drainage Slat Dev Chrg(SSDC) - PHONE: 10-230-505 TB.PD (452) -� - -- 10-435 TV" (51) ! ARCHIENGINEER 10-230--505 ftshingtov County Fire Ml. (952) NAME: 10.435 Washington County Fire #1 (52) ! ADDRESS: 10-27.0 Mart/Wedgewood 3 TO'1'A1 PRRPAID r u ._,. 11kTANCE DUE ! .� T1LANT STGNRE Received itv: --- __. __ Date __-- J� � PLAN CHECK APPLICATION CITY OF T167ARD Gl1YOFAWARD PLAN CHECK _ COMMUNITY DEVELOPMENT DEPARTMENT °"'O°" PERMIT i a125 SW 1 8?vd P.O.Bm 23391.T198M.OMW trrm(6M)6304176 DATE ISSUED JOB ADDRESS: /// J �- �,Q TH `�Al�-•� TAX MAP/LOT �� ti/ SUB: LOT: LAND USE: - r VALUATION: r,) SETBACKS: FRONT:-- REAR: LEFT: RIGHT: WORK CLASS. HEIGHT: TOTAL AREA: USE TYPE: y-Li F FLOOR LOAD: _ 1ST: CONSTR TYPE: -.y HEAT TYPE: 2ND: _ OCCUP GROUP: _h'_'/ DWELL/UNITS: _ 3RD: OCCUP LOAD: NO BEDROOMS: BASEMENT: NO STORIES: _ NO BATHS: GARAGE: IMP SURFACE: APPROVALS REQ'D SPECIAL NOTES ITEMS REQUIRED PLANNING: REISSUE OF: LIST SUBCONTRACTORS:_ ENGINEERING: LAST REISSUE: _ BUS TAX: _ FIRE DEPT. : FLOOD PLAIN/ CALCULATIONS: OTHER; _ SEN LND. : TRUSS DETAILS: _ PARKING PLAN: — I.ANDSCAPZ PLAN: PIAN CHECK BY: / 0 OTHER: COMMENTS: # `7 �, T'/� •• ACCT UN DESCRIPTION AMOUNT OWNER 10-432 Building Permit Fees NAME: __PCrZ 10-431-600 Plumbing Permit Fees _ ADDRESS: _aL__�yc 10-431-601 Mechanical Permit Fees s� 10-230-501 State - tllding Tax (Sx) s '� 75 10-433 Plans , ck Fee — PHONE: 30-443 Sewer nnection (20x) $_ 30-202 Sewer connection (80X) CONTRACTOR 30-444 Sewer Inspection t _ NAME: .51-448 Street System Dev. Charge (SDC) s �,— ADDRESS: 52-449--610 Parks I System Dev. Charge (PDC) _ _ 52.-449-620 Parks II System Dev. Charge (PDC) -�� 31-450 Storm Drainage Syst Dev Chrg(SSDC) PHONE: — 10-230-505 TRFD (95x) 10-435 TRFD (5%) — ARCH/ENGINEER 10-230-506 Washington County Fire I1 (95x) s NAME• ./-:_�� �;_) 10--435 Washington County Fire #1 (5%) ADDRESS: 10-220 Amart/Wedgewood 3 --- — - _ TOTAL PHONE: — --- PREPAID REC R L' ( `r c i_— BALANCE DUE APPLICANT SIGNATURE `! Received By: Date Received: _