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KELLY MARE KELU RB 1170 � • H16H GLOSS. �J eJA 1.OL.!7 Co CL 8. F1� 3. IioAI.L TILES (Ex1S1I46 IN I181' EId'9 DTII) TO B'E SAS . I OR SCUFF'E>t. FRINE ilI TH RELLv 1' iRE x l'H 400 MH I TE I. KW,., AIM HEADENS - DIF.Lt I PRIMER. PAINT NITN Z COATS V OIL BASE MWEL , B. JOISTS, LEDGERS - OF.L#2 SiEM'-6I.05S. DF.L STt D BFASE OTHER INTER'1% WALLS - I/V 6YPSUP IMLLPARD - PRIME 1 5. PLATG`1:iNE - F-L�3 AND PAINT WITH 2 COATS OF LAM CkAIEL SEMI-GLOSS. 0 �. PLATES - Sf.LS2 � S. E X TER;� I►�I.LE - STA I!V TO MATO! E X 15 T I IfB. .e---•-----_.�..._ ----' ____.__.._.r...__--__._.� __-______._ _,. ___ �. PT.Y1'D SH£RTIiI M6 1/0-.0 CDSa ------ 6. EXTERIOR DOtS - PAINT TO PATCH ELISTIN611 � .�, > 7. ALL MOOD IN CONTACT N1CONCRETE DIS EARTH TO BE PRE9SUIIE TREATED t_P.P,. �. MEt:HAt1l%At 9. NAILING TO K PER UBE TABLE 25f , - - - 9. P01101. SOLID PLOCVING UNDER ALL K" r APPRO ED FOR CONSTRUCTION I . C ItI£5 To St�,;1E1! TO 8E 8t1}Ptloft, >pw 8E.APIN POINTS CITY OFTIGARD 1 a,F I1E f�;.00s': OEk CODE. Z. EXH�AUS�t All. FA45 TO EXTERIOR THPOA4 FETAL DUCTS. � S. ELECTRICAL PERMIT NO _ , WTE ADDRESS � 00F •°""• �� _..._ c"r�3 . I . C4+ANOE5 4ND ADD;TIONS TO BE BIDDER DES19N SISTEMS. cc T C INSULATION w B ITLE_p DATE ' ; . EITER1% WADS R. 13 F.6. BATT , C. SURFACE FIITUPES IN KOSHOP TO BE SELECTED BY 11l1 1. ----.. 2. ATTIC R.30 F-6, LOM FILL . 3. ALL RErESSE r) CANE TO BE L 16HTOL IER SERIES 1100 � 3. P' LYISOCYAI"IMATE TYPE FOAM INSULATION b_RC� ifI1H kwITE 1F�1M I .C. iAbtEf�. w..o. Pr! w AT PLATES, COIR STOIi CAVI''!ES AND AROUND DCO, AG M I NDOU ROUSH OPENINGS. H. COARSE OF FIs. 114 - 4. WEATHERSTRIP ALL EZTERItut DOURS 1NEii' . I . G01{TI✓ACTOk IE RESPONSIBLE FOR CLEANING Ql�sINC ANG �� E." F- I �Y ALL C 0t° J v I T 10QiL., D. r`pl��► Gj �'r:.. T 11.r 1 Rf T EE COTt'3I R iC T I ON. Ir tr., c:Ca ►�.J ;, LJ 01 l hJ 2. COOTRAC'OP IS r E 4 PONS I BLE rOR ANY CONS TktlC'I ON � I . ALL TILE TC BE INSTALIET- 04 CLEM SURFACES FENCING ANGOR 6ARRIG.PDFS, PREPARED PER , R"' 041q. NDAzJ11 . 3. aITE TO HG P,'IIkTP.!IiEO c:wFf AND FREE Fit" . TILE TO 04 rLOOFS AVE CVIS. Ai L . Te 1 to �±� TILc3 Ye RE CE�L.EL' AFTEF tit' t IRS I'� �...'.,�,{.,il �..,•}i i ;��►:;:��.;'(�i(t� ,�,' �I .� �sl� [uPiNE, Ir 11100 0,11011 „1 �, I 111 � 1 �1 111111 111Fill' I � 1 X11 I + I 11 I1 II 1 11 III IIP IIT1 11;711 1 1 1 I I P I 1 1 1 1 1 1 I I I I I I I I 1 1 1 1 1 1 1 1 1 1 11 I I ' ll C 1 + I I l i l I I I I 1 11 I 1 I I I1 � 1 III II III � III 111111 NOTE : IF THIS MICROFILMED ^�-�-=-- ( • -� 2 3 4 5 6 7 8 9 10 I I 12 DRAWING IS LESS CLEAR THAN ' THIS NOTIGk; `1T 1S DUE TO THF QUALITY OF THE ORIGINAL ... D RAW I NG. ----- - ------- _ _ -". dE: 15l 82 tiiz 9z 9z bz f_!z zz 1? 02 61 81 LI 91 91 t, I El ?. 1 11 01 6 9 L 9 S ly c "MY*" -'''� l � �P!IIIIIIIII:i�I11111111II11111111111111i1ti�I111111111t111I1111�111111111VIIIIIIII�tIIlII111Illll�llll�ll lilllll11�11111111''1•lil�l II II I A T"I T A 9r) A QQ9 L1� Jl1i1111111{i�1.111illli�lllllill{�1111 .III{�Ilil�lll1�11IIIIIII�{III�IIII�IIII�II��IIII�IIIt�1111�1III�IIII�IIII�I1lltFlllll111�111i�1111�!ll�li.l_I�llllslillltla�llil I i r,� N• Ul 12 LO Ln n rt 0 1-t ro 15355 SW Royalty tirkway King City os► w w dTATE FIR[MARSHAL—PLANS -R`IOi.I MARSHALREVIEW 076. STATE OFFICE IRUILDIN. PORTLAND 97201 NOTICE OF PLANS REV i EW (THIS le NOT A NUILOINO PORMITI Building k1M9Z- 11!V GDI.F DR Q&nit tp_AnQ�_JS 3`i tl !TaA, f?o ALly .I !'L^L!4�_._ ,,jN eUILDINB ADDRESS K7 G I'J•ry County WA9H1WrA2tN Ckcu'+ency FZ •� kA :-�Sk.St31.�,5 Const, _._X—N Sound value;22 "S LTU Fee- na A Architect LEh PIERCE New Bldg. � AdditionX Alteration C] Date Received �tdk 1179 Owner 4:n NG Cr13U ['1 V/C A.$�QC° Address L!i_3_9CL..S k TN &Tt .l�(A _ -�-�--•-_. Date Reviewed�..ats�.b(tLQ7,3 Stories _L__ Aree /ice_A(i iA Attic / —� Fire Walls 10 NA Fire Escapes/1GxE_Exits /ZC ft, �TA L_M N PLO aASEN1.4T NT STOP% /SSD- tOi WIDTH Stairs Vert. Shafts/!(61��/ .`tL�— Sprinklers _�/-_"./ Man. Alarm 4N_,"S.P. /L44 r-_/ _ CLOf[D CLOSED NO YES AREA COVENEO INT flEt Ext. lcait. C" M. Det.G�G�4Y-Stµ1''�_...L1/ Floor lsdNCNa-• Ceiling 0 &P- Roof�N for. MembersIZR�1LD.CR_ CLA As NO TVRI AREA COVO �.r Well cover{�0—/P4,80 Mr. tm. encl. _1� J',j Type flu* SLSType Mg. System Nl!!1J �' IL�.Fuel 57�.S The submitted plans 'have been reviewed for conformity with fire protection statutes and regulations of Oregon admin- istered by this office Items No. 1/=L'J'—s,') _Z-7- checked on the enclosed list are applicable. These items and any specially noted provisions must be incorporated into the project to meet current fire protection regulations. Approval of submitted plans is not an approval of omissions or oversights by this office or of noncompliance with any applicable regulations of local government. REMARKS: >�4.L.�tfL kY�r�rrFf�o�r! T��:—�'�4s lIn►�T _I_ k" Ip•_'rrp_CiE__L�F -13-f�R1.I�+4��E�/_L�_L�i3EL—P-��- �tS�_�y,rfL'TifF ���1-,♦An_c'�_�lE2vr_C�. _ _ -l��l�11_LI2�._�!E I Mt^.Lus� ori �Ac T"fs E!g13L�i vE �r�A/tc__a��-�y�.NJS'.IK_'T_�E�E._iP1�QAi C WALTER S MARSHAL 77F�: yp -�^. ^`' ExaminedSTATE FIRE. M EET AL tri� �R'Try aaa CHURCH RTRECT N F sALrAI ONHOON 97310 Copies (WA/�K �T6�R�,�Ds�. D ;.----.�rAIT/,9l R ,f'D _ � � r l' ( 1 i t I i 1 ^�t 1 15355 SW ROYALTY PARKWAY -KING C'TTY i I � y,� .. �w, r n.. .•C w a »�a, t r � I rro p 04 iq co �a 00 4 y >1 CQ a t,4 to fu 0 , 4j 0 to v xclr f� i R7 O w V ( O V U a w b y r� •� a 04 O >. Q U 01 w OOj O UU ( U) 1� x 0 O bU � M 1J g > u r-1 Lncd _4 OM U O OD ) 'J '� U 0 ! a r= d O by w r 1l a dH 14 m 0 ( �C 1 4 � t' t I+ � r + o i a INSPECTION NOTICE C� City of Tigard Building Department P O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested_ � - Turn A.M. P.M. Address ___ =-��_— Permit Lot Owner — # _ BuilderThe following Building ;ode deficiencies are required to be corrected: Presented to __- ----- I Approved 17 Inspector / p ---_-- -_� ] Disapproved Date CALL FOR REINSPECTION El YES L_l NO FIFE PREVENTION BUREAU OFFICE OF FIRE MARSHAL 37829 INSPECTION NOTICE OWNER_ _ DATE — OCCUPANT .'K'"7�`'J C �?� t ill all ��'`' _OCCUPANCY LOCATION SOUR ATTENTION 19 CALLED TO THE FOLLOWING FIRE SAFETY DEVICIENCIES: za; 42 'ALLURE TO CORRECT THE ABOVE CONDITIONS WIT­PJ r)A.5 WILL MAME YOU LIAPLE TO r.gOSECUTION S"OULC rt"t RESULT FROM SUCH 'ONDITIONS YOU MAY At LIABLE TOR DAMAGES TO PFRSnNS OR P �f�T vt/UNDE9''P trOVISION! Or ORS 170 100 BY � C �'� •(/ �� WASHINGTON COUNTY FIRE DISTRICT#1 FIRE MARS14AL 20885 S.W. BLANTON STREET ALOHA,OREGON 97006 649.8577 PRESENTED TO FORM 900 10 FIRE PREVENTION BUREAU OFFICE OF FIRE MARSHAL- 37033 INSPECTION NOTICE OWNER-.-- ---,--L)ATE -- OCCUPANT /+T OCCUPANCY LOCATION VoUn ATTFIJTION IS CALL.EO TO THE FOLLOWING rinE SAFETY DIEFICIENCIESt Or 771 6 awl 14�1- ox? FAILURE TO CORRECT TNF AROV17 CONDITIONS *ITIIIN__r3Av4 "ll, I MAKE YOU LIASLF To rnoqrcUTION SIACULt' r'nF RESUI.T FROM SUC" CONDITIONS YOU MAY BE LIAMLr FOR DAMAGES TO PERSONS OR 0!, 6rrjkt, IJNtltn PMOk-IS-ONS Or one 479 190 A By_ WASHINGTON COUNTY FIRE DISTRICT#1 FIRE mA-W*-mAL 20665 S.W. BLANTON STREET PRESENTED TO ALCHA,OREGON 97006 649.8577 FORM 11110 40 BUILDINU.', PERM11 CITY OF T167A RD 1:1"WE'T NO . 8tJ88J.()-J1 CITAMM DAVVEG : I !Wl---:D: RD I COMMUNITY DEVELOPMENT DEPARTMENT 09160" 13125 S.W.Hall Blvd..P.O.Box 23397,Tigard,Oregon 97223,(503)639-4175 NtAYN I I I-KY TAX MAP/I 0`T' 17AJEA: 1<.I:N('.., C :L'T*Y I AND WSIE : 1..01 SlZE. . VAI LWIJON : !4 0 5 L-T*13 AC K 5 F;P(JIN r : 1:4L.AN WORK (:,'I ASS . AL-*T'F.*-PA'7*.'1(:)N DWEL.L. .UNI'rri : LEPJ' : r4MI-47' : w.-iri: ryr*,E : (,,'0MME:PG:r.AI NO. IL"IEDI.-MOMS : FX*I' .WALL (`,0N5*T' : C0N5'T' . 'T'YPF: : VN NO. BA'I'llili : N: S . E W C1C11UP . U11:4-1. . Bp P1407' .UPI ENINGS : (A:.,(J-JP . I OAD 78 IN W 7131 AL AREA: P 0 1112'15 t4(:) - Sil'0 WE EG 1.G U : P.5 POOP* CONS'I" : C F:*1 PE HIEl"? I I LA: : PND: API::*A PA*I'l-.D: BASE Mr-EN'T"? NO 3PD: 001CUP , CiEPAR'? M I.--Z Z A IN 3:IN E- W.) HASE M' I' 11_00n I OAD: 2!5 GAPAGE P"TP ' !'iPI4KI—A7 Al ARM F*I 0 W M K, J*YPE . GAS HIH3" . YEL3 (';(:)1 I4,7 reinticlei.l, Ki.ng (: :i.-t,y Shrip iiii-ld RElSSILIE 01" NO. rcmm% I AS'T' PET.1543LJIE (.'ity Giv,1,1. DEKRMIJ, *00 . 50 !iW 1.1.6t[l Aver F-11 AN PF.-.'V:I'[::W 41 115 P. 3 2 N King City OP 97AV3 F:'.1PF i)r--*i*-*,,r R I'AX 1. U3 L)I lArEP C 1-"nx TER V SDC(%'Vopm) 0 PAPP(,)11' OLIM A I'N UN SUC(LVT'AE,I--J) OLIN'T A I'N 1, V, I N 62.605141 T V, R ill r wrrracl OP 971.40 A PF4E:PA:I:D < $134.53> C 6963 T PI:::CO3.5*T*AA'T'TAM 2237 � 14YVAL. : 11118-1. 15p 0 NO . ;31.61.1 ...._..._.._................_. ............. This permit Is issued subject to the reguiltil*contained In Title 14 REQU-1 PEO 1:NtiI--'EC-1-J.0N1S of the TMC, State of Oregon Specialty Codes, zoning regul tions Sill-Ari and all other applicable codes and ordinances. and if is hereby agreed that the work will be done in accordance with the plans and F"PAKENu specifications And in compliance with all applicable codes and 1NS1JL.A'1 10N ordinances The issuance of this permit does not waive restrictive GYP . DIIJAPI.) covenants Contractor and subcontractors shall have current city F*f NAL 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 re spections are requested and approve -ermittee Signature :I:NSr)Ec,'rT0N 639 11 V� Issued B SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE PLUMF)J:N(.v P1-*:jJ- MJ:*T' CITYOF TiGrARD I' W.) . : PL-88:1.043 C160— MID A� RD COMMUNITY DEVELOPMENT DEPARTMENT 01100101 DAVE ISSUED: 6/ 3/88 13125SW Hall Blvd.,P.O.Box 23397.Tigard,Oregon 97223.(503)639AI75 l`-"P.*l.'M PM V.NO (38 1. Al 1. JOE.", ADDPRGS : :1.5ZJ55 SW NOYAl T*Y Pl<y .1.AX mr.)I-,/l 5(Ail . KINCA CITY I AND U!W : IIIK : 1 01, SIZE : WOW< CLASS : Al...*I'F_:PA'f':I:(:)N 11 EM: NO: NO . WA TEP CLOSEJ 'I PAP 'T*yPE: (.1PTNAL HKF I OW F)PVNTP (`,0NG*1 . l'ypE. VN LAVOPAI'DAY 744AP PPTMEP 0("('J-11*-*' GRP . TIM 51-10WEP ► GI:4r-.*. 5E TPAPS 0:1:5HWASHE"A GAPEIAGE: DISI:"(35AI NC) !:04.11PICKS: WA5H:1N(-'-,' MACHINE DWEI.L. - 1.)N]:I*S : LAUNDRY J*PoY r-311 DG9. DPATN (DIA 1:1 00114 DWAIN GINK WAIEP HE"A'VLP STOPM/114AIN (F—T. O'T'HEn REMAPKG . (-ZiR.PPed -J 0 KJ.rq.1 City (.,'ivic At-l%nr--ir.Lt:1r.1r1 W PE:Rh], T N 13P.45 EM 1-1.6th Ave- $60 . 00 E KJ.n y Ci.tkl 014 9!'P23 FT X*1 U PE S S T'A'1'1-:: 'T'AX 111113. 00 C 1.1f. 0 0 N T R A C T 0 L R I- I,()VAL: >ti i I1 ci ii This permit is iss jed subject to the regulations contained in Title 14 P F.r.C E.I P,I IN I) . of the TMC. State of Oregon Specialty Codes,zoning regulationsraj PE:Q1-J1Pl::.A:) and all other applicable codes and ordinances. and It Is hereby agreed that the vork will be done in accordance with the plans and 14 UNDEPNIi.An specifications rind in compliance with all applicable codes and ROUGH Y N ordinances Th,! issuance of this permit does not waive restrictive P1.13 , TOPOUT, covenants Coiitractor and subcontractors shall have current city Fl:NAI business tax parmits 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 ,;onimenced It shall be the responsibility of the permittee to Fissure all required inspections are requested and approved. Permitt Eiqnattaire (IB y 16 _.J ij SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN L;FqCRIBED ABOVE CITY OF TIGA RD oQEooN June 2, 1.988 / David Baxter Parrott Mt. Construction 16260 SW Bell Road Sherwood, OR 97140 Project: King City Locker Room/Pro Shop BP No. 881041 Dear Dave: Plans for this project have been reviewed for conformity with applicable codes and are approved, subject to the following iteme: /l 1. Provide load and anchorage details for new beam !n pro shop, if e,cisting beam in removed and replaced. 2. Provide e Aame information for new post. 3. Install wainscot in toilet and shower rooms as requiredection 510(C) , Oregon Structural Specialty Code (copy attached). ��. 4. Provide detnils on mechanical alterationa. If you have any questions or if we may be of assistance, contact us at any tire. Sincerely ��L ti A ` ,Jim Ja,; a Plans Examiner ke/5154D cc: Olson Group Architects, AZA 13125 SW Nall Blvd.,F.O.Box 23397,Tigard,Oregon 97223 (503)639-4171 ---- � A 4& Washington County Fire District No. 1 City of Beaverton Fire Department Tualatin Rural Fire Protection District I l01 •!► May 26, 1988 D.A. Baxter Parrott Mountain Construction 16260 S.W. Bell Road Sherwood, Oregon 97140 RE: Ring City Civic Association Locker Rm-Pro Shop Remodel 15355 S.W. Royalty Parkway Dear Mr. Baxter: A fire and life safety plan review was conducted oa the above captioned project for compliance with the 1985 editions of the Uniform Building Code (UBC), Uniform Mechanical Code (UMC) , and Uniform Fire Code (UFC) as amended by Tualatin Rural Fire Protection District's Ordinance 86-5. Plans are approved as submitted subject to the following items: 1 . Exit Door Hardware: All doors shown on the drawings must be openable from the inside for immediate exit at all times without the use of a key, special. knowledge, or effort. (UBC Sec. 3304) 2. Exterior Exit Door: Hardware for the exterior doors and key operated deadlocks may be permitted where there is a sign posted on or over the door reading, "THIS DOOR MUST REMAIN UNLOCKED DURING BUSINESS HOURS" in letters not less than one inch in height on a contrasting background. (UAC Sec. 3304) 3. I.atifi.ngs at Doors: There must be a floor or landing on each side of all doo:5. 1'he floor or landing must not be more than one inch lower than the threshold of the doorway unless serving access for the physically G.andicapped. (UBC Sec. 3304(h)) 4. Firest_opping: In all wood-framed walls and partitions, fire stopping consisting of 2-inch nominally-sized lumber or other approved materials must be installed at all floor and ceiling levels. Penetrations in this prescribed fire stopping to accommodate wiring, plumbing and other similar utility runs must be packed with noncombustible materials in an approved manner so as to prevent the passage of flame. (UBC Sec. 2516) Parrott Mountain Construction May 26, 1.988 Page 2 5. Inspections Required: Inspection and approval of construe-tion by a representative of this office is required: (a)prior to the cover of any new framing elements following the installation of all utility runs which will be concealed within wall and partition cavities; (b) upon completion of construction and prior to occupancy of the tenant space. (UBC Sec. 305) 6. Approved Plans on Job Site: One set of approved plans bear-ing the stamps of the Tigard Building Department and this office must be maintained on the project site throughout all phases of construction and must be made available to build-ing and fire inspectors for reference during required construction inspections. (UBC Sec. 303) 7. Certificate of Occupancy Reuq ired: Prior to the use and occupancy of the project (space), a certificate of occu-pancy or other written instrument of approval must be obtained from the City of Tigard Building Department. (UBC Sec. 307) SPECIAL NOTICE: DEVIATIONS FROM THE SUBMITTED AND HEREBY CONDITIONALLY-APPROVED PLANS DURING THE COURSE OF CONSTRUCTION, EXCLUSIVE OF THOSE NECESSARY TO COMPLY WITH FIRE SAFETY REQUIREMENTS AS LISTED HEREIN, ARE PROHIBITED WITHOUT THE WRITTEN AUTHORIZATION OF THE WASHINGTON COUNTY BUILDING DEPARTMENT ANI) THIS OFFICE. If I can be of any further assistance to you, please feel free to contact me at 649-8577. Sincerely, WASHIN ON C0 TYhRE DISTRICT NO. 1 i Bert arker Fire Marshal 20665 S.W. Blanton Street Aloha, Oregon 97007 BP:kw cc: Tigard Bldg. Dept. ✓ District Inspectors Area Inspectors C17YOF TIGARD No. 31611 i 13123 S.W. HALL BLVD. � I P.O. BOX 23397 Date 1 1 13ARD, OP 97223 J __ a Name Address — — -- — — Y Lct B-oc—k/Map-Subdivision/Address — Permit ff's Bldg. Plumb Cash Check 1 Sewer Other Other—_ Rec. By Acct. No. _ Description Amount 10-432 Building Permit Fees 10-431-600 Plumbing Permit Fees 10.431.601 Mechanical Permit Fees — 10.230.501 State Bldg. Tax 10.433 Plans Check Fee_— 30.443_ Sewer Connection____ _ _30.444 Sewer Inspection 51.448 Street Syst. Dev. Charge .52-449.610 Paras I Syst. Dev. Charge 52.449-620 Parks II Syst. Dev. Charge 31-450 Storm Drainage Syst. Dev. Charge _ 10.430 Business Tax _ 10.434 _ Alarm Permit —' 10.227 Ball 10.455- Fines - Traffic/MIsd/Parking -- — 10.230- _ CFTA Traffic/Mild/Vic. Asst. 10-456 Indigent Defense — 30.122.401 Sewer Service/USA �- 30 122 402 Sewer Service/City 30% 30 123 Sewer Sevlce/City Malnt. 30.125 Unmatched - — -- 31.124 Storm Drainage —' 40.475 B,�ncrott Prin. Pymt. —��- 40.471 Bancroft Int. Pymt. i - -_ —-- ---_� TOTAL - DEPT. �f 1 now w CIT1 Of KING CITY 153PO S.W . 116th AVENUE K;NG CI i Y , ORECOA '47724 ( 5U3) 639-4092 APPI ICAI I1lN FOR COMPLIANCE REVIEW BOARD PERMIT 1 . NAME OF APPLICANT : KI14G CI'T'Y CIVIC ASSIN ADDRESS: 1524c Sy1 1].(i TELEPHONE NO. 639 6565 ADDRESS OF PROPOSED IMPROVEMENT 1�35� OW ROYALTY PARKWAY 2. TYPE OF CHANGE , IMPROVEMENT OR CONSTRUCTION FOR WHICH PERMIT IS REQUESTED. (DESCRIBE BRIEFLY/ATTACH TWO COPIES OF PLANS OR DRAWINGS OF WHAT 15 PROPOSED) : 3. NAME AND ADDRESSES OF CONTRACTOR : OUT FOR 11111 4 . NA'SES AND ADDRESSES OF NEFGHBORS WHO MAY BE AFFECTED BY THIS CHANGE , IMPRDVEMENI OR CONSTRUCTION . ( IT IS THE APPLICANT ' S RESiPON5I131LITY TO NOTIFY EACH NETG'i130R ) : IJONh CONCI-diNLD T1J7�;iLIOit OF' DRF;5:;ING Rt)M'L; AT THE Plip!!SNOT'. SIGNATURE OF APPLICANT '- T DA I F OF APPL ICA T i UP4_5/3��8 OFFICE USE ONLY : ~� APPLICATION RLCEIVED BY DATE APPLICABLE FEE RECEIVED $ 10.00 OTHER TOTAL_ PAID APPLICATION REVIEW SCHEDULED : DAIL_ _ CUM[-%L IANC REV=1 )ARD - DLCISI.0-NUJ: APPROV DATE_ '-`�/� g J" ti GENIF0 "7 0A GONDII10W', I 10/87 ( Information/Instructions on reverse)