15935 SW ROYALTY PARKWAY I
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15935 SW Royalty Parkway _
King City
INt3PECTION NT19E
city of Tigard '..riilding DOPSN'taent
131251 SB Ball Blv11_ Tigard, OrtMon 97221
Inspection Lina (Rec-O-Phone)s 639-4175 Laeineas Phone: 639-4171
Inspection:_ _ ---
Footing Plbg. Underslab Mech. Rough-in Appr,'Sdwlk
Found. Plbg. Top Out Cas Line FINAL:
Poet/Roam Struct. San. Sewer Framing Bldg.
a
Poet/Ream Mech. Rain Drain Insulation -Plumb.
I
Plbg. Underfloor Water Line Gyp. Bct. -Mech.
Date llequested:_— L ' Lws AN PH
CO
Addrese:_ /S #Buildors
Cro � " /
1HN M� .I MM0 CORRECTIONS ARS RBQUIRBD:
Inepsotors_ Date
i
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
__Call ►or Reinsp.
INuPE(TX. N_ NOTICE
City of Tigs Build Log Department
13125 M Bali Blvd. Tigard, Oregon 9722
Inspection Line (Rec-O-Phone): 539--9175 Business Phone: 639-417'
'.nspect ion:-_____ —_-. —_•-�-
Footing Plbg. Underslah MOoh. Rough-in Appr/Sdwlk
Found. Plbg. Top out pas Line FINAL:
Post/Beam itruct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation) -Plumb.
Plbg. Underfloor Water Linep Gyp. Bd. -Mech.
Date Requested:___ ` Times r-4.-AM PM
Addrene: W. C: •T
Mii i.der
THE FOLLOWING CTIORB ARE REQUIR=Ds
s
F
r; Q'
1nelu•rtoc:_—� Dates
APPROVED DISAPPROVED APPROVED SUBJECT TO AFIOVF.
Call For Reinsp.
i�
V
JP"jr-n ICE
City of Tigard Building Depart'r±nt
13125 SM Dell Blvd. Tigard, Oregon 97223
Inspection Line (Rer_-O-Phone)t 639-4175 Busln?sm Phone: o39-4171
e
Inspection:_.
Footing Plbg. Und?.1.b Nech. Rough-in Appr/Sdwlk
;a
Found. Plbg. Top Out Can Line FINALt
Post/Beam Struet. Ban. ewer Framinq -Bldg.
fi
Post/Beam Koch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Mach.
G_
Date Requested: �CJ �� TLxwt _!IM PM
Address!�yr5n , Coit �� '
r� f
Builder= -/�_ L t' C 1,L � D - 3/ -
i
TIt16 FOLI.OWINg CORRE(_'TIONS ARE RRQUIREDt
Ji
l
r
Inapectort'_110�1?%'F1�' - � _ Datat L�
APPROVED DISAPPROVRD APPROVED SUB.TECT TO ABOVE
Call for Reinsp.
�NRP�ION N(1T,IC:E
city of Tigard lkiilding Uepartssnt
13125 Sp Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)e 639-4175 Bueinene Phone: 639-4171
Inspection:----_�
Footing P1bg. Underslab Hoch. Rough-in Appr/Sdwlk
Found. Plbg. Top Oust /� Gas Line FINAL:
Poet/Ream Struct. San. sewer raining -Bldg.
Pont/Beam Hoch. Rain Drai6 Insulation -Plumb.
Plbg. Underfloor Nater Litre Gyp. Bd. -Hoch.
bate Requested- - `l Timet AH �P/H
Addreen:
f F— rrr
Builder: (J
THE FOLLOItI CORRECTIONS ARE REQUIRED:
l'
Inspector:. �� - Date$
_/—APPROVED DISAPPAOVEO T4 APPROVED SUBJECT TO ABOVE
Call For Reinsp.
INSPECTIONN_OTICE
City of Tigard Buildioq Departseant
13125 Rif Ball Blvd,. Tigard, Oregon 97223 ti
Inspection Line (Rec--O-Phone): 639-4175 Business Phone: 639-4171
Inspections
Footing Plbg. Underel.ab Mach. Rough--in Appr/Sdwlk
Found. Plbg. Top Out sae Line FINAL:
est/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mach. Rain Drain Insulation -Plumb.
Plbq. Underfloor Water Line Gyp. Bd. -Meeh.
Date Requested: 1 - 7 Time AN �—PH
Address: a'eDit/#1
Builder: v7 v1f
TB= M14 OORRBCTIONS ARE REQUIRED:
o�cc',Z
i
I'
E
Insrw,ctort_ —_ — ---- Dater
4OPRMD DISAPPROVED APPROVED SUBJECT TO ABOVE
Call
?or Retnap.
INsr CTION NOT1
City of Tigard BulldIng Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)t 639-4175 Buei.ness Phone: 539-4171
Inspetxtiont
rooting Pl.bg. Underelab Mach. Rough-in Appr/Sdwlk
ro�und.� '_'ibg. Top Out Gas Line FINAL:
lKfl st/DBm Btruct. ' San. Sewer Framing -Bldg.
Poet/Ream K&7h. Rain Drain Insulation -Plumb.
Plbg. underfloor Mater Line Gyp. Bd. -Mech.
Date Rer{uestedt ,? NN�AA Usiet a. A14 �� /__PM
Address: IX �� . POrsit �t /n ��- `f
l J
d
Ruder: YI/�lk lei (I-A.V 11.i %-2,b Ln1 31
THE FOLLOWING CORRECTIONS ARE REQUIREDt
I
i
r
inep�otor '7
__ Date —
APPROVRD DIMPPROVRD APPR(WrD SUBJECT To ABOVE
—_-Call For ReinaP.
INSPEr."NON NOTICE 7
City of Tigard Building Deparunt �7
13125 811 Ball Blasi. Tigard, Oregon 97723
Inspection Linz (Rec-O-Phone): 639-4175 Business Phones 639-4171
inspections
F wting Plbq Onderelab Much. Rough-in Appr/8dwlk
Found. Plbq. Top Out Gas Line IINALc
Poet/B9am struct. San. Sewer Framing -Bldg.
Poet/Bean Mech. Rain Drain Insulation -Plumb.
Plby. underfloor Nater Line Gyp. Bd. -Mach.
n /
Date Regsseetedc _Tivet
k
Address
Builders s `
THE FOLLOW NG CORRECTIONS ARE RIQDIREDc
Inspector: Dates.
APPROVED DISAPPROVED _ — APPROVED SUBJECT TO AnOVE -
Call For iteinsp.
INSPECTION NOTICE
City of. Tigard Building Departmmt
13'_25 SM Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Businens Phone: 639-4171
I nspect L.n t
f
ng 1 Plbq. Uncteralal+ Mech. Rough-in Appr/Sdwlk
Found. Plbq. Top Out Gr•:. Line FINALt
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Bean Mech. Rain Drain Insulation ._Ply•
Plbq. Underfloor Nater Lino Gyp. Bd. -Koch. ,�)
Date Requeeted:_�5 -leiC+ W"
Times AN
Addrean:.
It It (:?/ /
\
Builder: Irl` •1
C Arl
THE FOLLOWING CORRECTIONS ARE RRMIRED
c
�.��---T�
f
inspector:__ / Datet
----APPROI'ED DISAPPROVED APPROVED SUBJECT TO ABOVE
call For Reinap.
CITYOFTIGARDQ
MYOFiVAND M06 I E:H PERMIT
T
COMMUNfTY DEVELOPMENT DEPARTMENT onoon w'ERM:Ui . . » . . . . : MET91._0094
13126 SW Hell Blvd. P.O.Box 23397,Tlp W,Orepon 972?3(603)830.4176
.TE. F DDREGiS. . . - i'f-1f?C:F_"I C.'.::; k C�
:;L1PL)I V 15I CIN. . . . : k i 41 ZONING:
------------ BUIL.DINC3
REISSUE: DWELLING UNII'St l L3ASEMENT. ., » . » . . » :0 ;f
LlPbb CJ E- WORK. :ADD BE:DRMS:0 BATHS: 1 GARAGE. . , . E. . . . . . :0 s f
TYPE OF' I.JSi » . . :': r r'1._f1OR AREAS-----_ !21"0LJI RE;.) T"DAC".1'.C;__...._._.._.,_. _.._ .
TYi-JE OF CONST. :5N F1RST. . . . :40 S LEFT. . :O ft RIGHT. :lb 'Ft
ClCCwUPANC:Y GpP. : R2 SFC.'OND. . . :0 of FRONT. -0 ft REAR. . . 0 Ct
STORIES. . . . . . . : 1 THIRD. . . . -0 S REOUIREI)-
IAF:I GHI.. . . . . . . . - 15 ft , '1TAl_......._._.--- t 40 S f 5MOVE DETC=C`T(.TRS.
t-!_ULJH LL.PD. . . . :40 FTs f VALUE. . . . . $ : 1840 PARKING SPACES. . :0
Rgm:ar^k� . addit i or, of one loath r,00m
Pl._UMBINCs
:0 FLOOR CSE A I N a. . . . :0 nAC;KFLOW PRE'w VNTRS. . :0
LAVF+'rORIE5. . . . . : 1 WATER HEATERS...-0 TRAPS. . ,. . . . . . . . . . . :@
TUC�,•514OWER a. , . , - 1 LAUNDRY TRAYS. , . :0 ( rMLH 9SIN.3. . . . . . . :0
WAT V.R ULCIE:E. r;.3. . . 1 SE=WER LINE: (ft ) . :0 GREASE:. 'r RPPS. . . . . . . .0
0I SHWA5HE_R5. . . . :0 WATER LINE (ft) . 0 OTHI='R F IXTi.1RES. . . . . -0
UARBOGE. D1 SP. . . -0 RAIN DRAIN (ft ` . :0
!JASH I NCS MACH. . . 1 0 '.:)F RAIN DRAINS., :1.A
_.__.. ..__.._.____..._ ME=CHANICAL_ _._._.._ __......_._ _. ..__ ___.___ _.. __.__ __.__....__ F'FES
71JE=1_ UNIT HTPS. . :0 t Ype amo+.rnt b%"' dat e r.ec.r.+
VENTS . . . . . :0 DPRT $ 31. 00 JLH 05/24/91 -
APY. I NI'::'l)r .0 01 U JEAN"T FANS. . w 0 BPLC $ 'w0. 15 JLH 19:1
URN ( 100K . . :fit HOODS. . . . . . ..0 B5PC It 1. 55 JLH 05/ 4/91 -
URN i --100K .. . :0 W01']DST 0VE:Ci. s0 P'PR1 4. J%'5. 00 .JLH 03/24/ )1
-LOCIR FURN. . . . :0 CLO DRYE':RS. : 0 F'5PC+ $ 1. c'5 JLH 175/24/91
'AC:1TI. "f-_MP i 3HP:O OTHER UI,,11TS:0
CAS C)UTL_E=TS:O
Jwne±re
RANO,'IS GAVIN
59- b "kW ROYALTY PARE<WAY
o< 1NLS C.1iY OR
i4laner #: &P5-6131
713. 95 T(:ITAL
This re-ert is issued subje^t to the regulations contained in theREOUTREwD INSr'E('TICINS - - --
'aaard Musicloal Code. State of fire. Sneclalty Codes and all other Foot/found Insp Plumb Final
Aoulieable laws. . 11 work will be done in accordance with aooroved F-Iast/Peta9m Stro. t D�tl ldinr* Fir.Al
_vs, This eerelt will eKcir'e if work is not started witrar. 180 PL.M/UndPr-fIoor Erasion Control
lays of issuance, or if work is susoended for Bore t 198 days, 1:.'I timh i orl 04.1t
rr
Framing Ins p
�+,nt?. tt:we+ !J r.tlrr.iil: trw : ��i9L.�e.
0rr9U.ltotxon 0r ,;p
Gvp Board Insp _.
Rain 0»,,kir) Tnsr1
("all for inspection - 6:39•-4175
CITY OF TIGARD - RECEIPT OF PAYMENT RECE I PT 1,10. x 91-•2.1 3640
CHECK ()Mf)(Jl',l T r 78. 95
NAME m GAVIN, FRANCIS i"ASH AMOUNT 0. 00
A D 1)R E'S C, r 151935 SW ROYALTY PARKWAY' PAYMFN"r DATE r 05/24/91
KING CITY, OR 9-7224-
t''IRVUSL OF PAYMENT AMOUNT V-"A I D PURPOSE OF PAYMENT AMOUNT i-.,A I D
TLDING PERM 31. 00 PLUMBING PERM 25. 00
BUILD PER 2. 84) PLAN CHECK FE 20. 115
TOTAL f-IMOLINT PAID 78. 95
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Cr13izs SW Hall BW. PLNCK/RECT #
CITY OF TIGARD f'O
aox23397 PERMIT a
COMMUNITY DEVELOPMENT DEPARTMENT Tigard,Oregon 97223
(503639-4t» DATE ISSUED
— JOB ADDRESS: SGS /�'< J TAX MAP/LOT S// 0C
SUB: LOT: LAND USE:
VALUATION:
OWNER SPECIAL NOTES_
NAME: /ta `� S J_ s��G �J REISSUE OF:
,ADDRESS: -5t&' Roc, 114a LAST REISSUE: __—
i
FLOOD PLAIN/
PHONE: SENSITIVE LAND: _ ^"
CONTRACTOR APPROVALS REQUIRED
NAME: >' "1 _ PLANNING:
ADDRESS: ENGINEERING:
FIRE DEPT:
PHONE: OTHER:
CONTR. BOARD N: EXP DATE:
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: S, ��� LIST/SUBCONTRACTORS: �—
MECH: !%/<'1 � _ BUS TAX:
ARCH/ENGINEER CALCULATIONS:
NAME: — TRUSS DETAILS: _ !_
ADDRESS: — OTHER:
PHONE:
PROPOSED BLDG. USE:
COMMENTS:
)?
APPLICANT SIGNAT
Received By: — �' Date Received:
K RMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL.. DUE
10-432 00 Building Permit Fees V,00 31,vo
10--431 00 Plumbing Permit Fees „t S,uy �,,,
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5%)
Building /3�
Plumbing
Mechanical
10-433 00 Plans Check Fee ?w./7 _ 0 / .01
Building
Plumbing
Mechanical
10-230 06 Fire
30-202 00 Sewer Connection
30-444 00 Sewer Inspection
25-448-02 Commercial TIF Fees
25-448-04 Industrial TIF Fees
25-448-06 Institutional TIF Fees
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 (PDC)
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC) _ _�----
2.4-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of) —
TOTAL-
nm/3j87P.WPF
KING CITY
WNNNWEE � 15300 SNV. 116th Avenue,Ring City,Oreton 9-1224 Phone:639.40S3
COMMUNITY DEVELOPMENT
APPLICATION FOR BUILDING PERMIT
(Instruc',ions ca reverse)
DATE AV-/
1. N1*14E d APPLICANT: , ti��, T Phone No.-
ADDRESS:
o.ADDRESS: / ` j 3Z1� 'o 1. !'l e
ADDRESS OF PROPOSED IMPROVEMfl .x
2. TYPE OF CHANGE, IMPROV71AE24T OR CONSTRUCTION FOR WHIM PERMIT IS REQUESTED-
DESCRIBE
EQUESTED.DESCRIBE BRIEFLY - ATTACH TWO COPIES OF PLANS QR DRP34INGS OF
PROPOSED PROJECT: /�!�, / T�p N ` r l1'17-,Zl
3. NAME AND ADDRESS OF CONTRACTOR
PHONE NO.- _ _LICENSE NO.
4. NEIGHBORS WHO MAY BE AFFECTED BY THIS PROJECT WILL BE NOTIFIED BY THE CITY.
5. APPLICANT OR HER/HIS REPRESENTATIVE MUST BE PRESENT AT THE PLANNING C '24ISSION
MEE I'I NG NEXT HELD ON
REPRESENTATIVES NAME PHONE N0.
(the Fing City Planning Ccrmission will consider only those applications received at least five (5) daps
prior to a meeting.) '
S I GNATURE
**********************************************************************************
APPLICATION RECEIVED BY ! Cs' — DATE r��
APPLICABLE FES; RECEIVED Ste,? a`` TOTAL
Pd-
PLAN14TNG COtdMIISSION DECISION: Approved Denied
CONDITIONS J '02-
• 1 C�'
1lpprcved fpplications are valid for sit mon hs only /
Signature, r, c k _ Datev S//,2/ _
NOTE: Oregon Boteluilders Law requir s that all persons who contract fo--r work on their residence be
registered with the Builders Board which means the contractor is bonded and insured on the job site.
For your protection, be certain your contractor is registered by calling city Ball Ph: 639.4082,
NOTE: A permit. mist also be obtained from the City of Tiqard Department of
Cormnmity Development YesNo
CITY OF TIGARD INSPECTION REPORT
The above listed project has been inspected and Approved Denied _
Date Corarents
Signature____ _
(13ui,e g iMpec to L pPeNe n.
Se tuAn. orte- (1) copy to Vi.nq��l1C-Lty)
cD 2-81 Pans have -7`-D he QlVt-c jlt c>l �r ion- Gv (2ons11 ac>i6)17 .
J�
KING C: Z TY COk4k4UW I TY
DEV t-LC.3PIMENT
A PERMIT IS REQUIRED FOR ADDITIONS TO; ALTERATIONS, 14ODIFICATION
OR RECONSTRUCTION, OF EXISTING BUILDINGS; INSTALLATION/OR RE-
PLACEMENT OF HEATING AND COOLING DEVICES; CHANGING, ADDING/OR
REPLACING PLUMBING OR ELECTRICAL WIRING; DRAIN LINES, FENCES NOT
IN CONFORMANCE WITH ORDINANCE NO. 0-89-5, OR NEW CONSTRUCTION
WHETHER RESIDENTIAL OR COMMERCIAL
INS'IRU IoKs
1 . FEES IN AMOUNTS SCHEDULED IN RESOLUTION R-89-8 MUST BE PAID
AT THE TIME YOUR APPLICATION IS SUBMITTED.
2 . TWO ( 2 ) COPIES OF A PLAN/OR DRAWING OF THE PROPOSED PROJECT
MUST BE SUBMITTED WITH YOUR COMPLETED APPLICATION.
3 . THE KING CITY PLANNING COMMISSION CONSISTS OF SEVEN VOTING
MEMBERS APPOINTED BY THE CITY COUNCIL OF THE CITY OF KING
CITY . THE C014MISSION HAS AUTHORITY TO MAKE ADMINISTRATIVE
DECISIONS RELATIVE TO LAND USES AND TO MAKE RECOMI4ENDATIONS
TO THE CITY COUNCIL REGARDING CONDITIONAL USE PERMITS AND
OTHER LAND USE PROPOSALS.
4 . THE RESPONSIBILITY FOR COMPLIANCE WITH REQUIREMENTS TO
APPROVE BUILDING PERMITS LIES WITH THE APPLICANT . AFTER
RECEIVI14G AN APPROVED PERMIT FROM THE KING CITY PLANNING
COMMISSION, YOU MUST ALSO (when appropriate) APPLY TO THE
CITY OF TIGARD FOR A PERMIT (you will be informed at the
time your apFlication is approved by the King City Planning
Commission whether this is necessary) .
5 . WHEN INSPECTION BY THE CITY OF TIGARD COMMUNITY DEVELOPMENT
IS REQUIRED, A CITY OF TIGARD APPLICATION MUST ALSO BE
COMPLETED. UPON COMPLETION OF THE PROJECT, PHONE: 639-41.71
FOR AN INSPECTION OF THE WORK. OTHERWISE PHONE: 639-4032
FOR INSPECTION BY KING CITY PERSONNET
6. APPLICATION MUST BE RECEIVED AT LEAST FIVE ( 5) DAYS IN
ADVANCE OF THE PLANNING COMMISSION MEETING DATE (9 : 30 a .m.
on the second Wednesdays of every month in the Council
Chamber i.n City Hall ) . APPLT.CANT OR HIS/HER REPRESENTATIVE
MUST BE PRESENT AT THE MEETING TO ANSWER QUESTIONS THAT
MIGHT ARISE.
NOTE: FURTHER INFORMATION MAY BE OBTAINED BY PHONING
KING CITY HALI, (639-4082 ) .
REFERENCES: ORDINANCE NO. 0-89-4 and RESOLUTION NO. R-89-8
CD 2-87
C11YOFTIOARD MRD PLAN CHECK APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT PLAN CHECK 22 R, .
13125swwBt#d P.O.B=2X40.74wd.0r"67 (6o 0((417 PERMIT
DATE ISSUED 7
JOB ADrQFSS: c c r' f .
5UB: �: CJ ' ..7 LJ A' �I,�Ll.• �tt}��G fj° TAX MAP/LOT�S�/-_/OGS-U3GoD
$ t'�� y- T• LAND USE:
VALUATION: SETBACKS: FRONT: REAR: . LEFT: RIGHT:
WORK CLASS: HEIGHT: 1,r 1-- TOTAL AREA:
USE TYPE: FLOOR LOAD: _.. , IST: %
CONSTR ;RPS: HEAT TYPE: f` �. 2ND:
OCCUP GkOUP: DWELWUNITS:— _ 3RD:
OCCUP LOAD: NO BEDROOMS: CEMENT:
NO STORIES: ` NO BATHS: GABAGB:
INP 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:
LANDSCAPE PLAN:
PLAN CHER BY: OTH":
COMMENTS:
n�U IIT .,* 140cT N DESCRIPTION Af'kXii"r f ,^,."1C';.NT PD. BAL. DUE
10-432 00 Bu4 lding Permit Fees
10-431 00 Plumbing Permit Fees
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5X)
Building l� 4 .S
Plumbing
Mech
10-433 00 Plans Check Fee �
Building
Plumbing
Piech _-
30--202 00 Sewer- Connection
30-444 00 Sewer Inspection
51--448 00 Street :system Dev Charge —^-�-
52-449 00 Parks System Dev Charge (PDC) _
31-450 00 Storm Drainage Syst Dev Chrg10-230 09 FRED
10-230 06 Washington County Fire N1 (95X) T--- -
10-2.20 00 Amart/Wedgewood -- --� -�
1 OTAI �� �-
REC y
APPLICANT SIGAYATURE ---- - -- '��^
Received By: _-- ��— -, Date Received:
cn/3587P/18P - --- -_-
0wl'
CITY OF TIGA.RD
ITUM BI NG PE".R M rr 13125 SW HALL BLVD.
P. O. BOX 23397
Al,p"ads must txold Oregon Registration to oondud a plumbing T I GARD, OR 97223
business or must be Property owner/operator no(hhing outside help.
m
gae d Devekgmwl — (503)639-4175
Plunpbing Permit No.
Address Dasa Wo _
ORS 1114-21-110 DUAN. PRICE MAT.
Job Tax La Map.No — ---
Address
---
l.ot Mock Srb6vlslon FIXTURES--.---—— — --
Sk* 750
are-�nart�e rroass� Lavatory 7.50_ f'!)
Tub or TutkShow`r Comb. 7.50 b r
su ---
Shovwonly _ _ _ 7.50
Owner Clip/State 24) -- water Closet --- 1 _7.50 v
oisrprrasher 7.50
— Phone Garbage Disposal ---- 7.50
_— Naurre — — Was"Machine 7.50
Floor Iran - 7-50
Phone--- Waterdealer ----- - 7.50
Occupant /State -- Laundry Roan Tr ay —� 750
City Tip
thinal 7.50
---'�
Name Other Fatures(Specify) 750
7.50
Phone - -- �—
7.50
Contractor Cloy/State -- —_�— Zfp 7.50
—_ — MISCELLANEOUS
City Bene Tax No Sewer 154 100' _ 30.00
tateBldp.Board Wo----StMe jTp. Hewer-ea.Ad(*L Ito —_ 15.00
(ResdentiaQ water Service 1st 100' 20.00
I trreby w-*x0wledge kmt I Tuve read this appilcafor%the the irdonnation Water Service ea.Addit2D' — 15.00
green is sorrel.that I am registered with the State DuAders Board.and also Storm R(lain(rain 1 st.100' 30.00
twvv a Stall Pkenb4q license kat the numbers given are eorrem_tat el — --- —
pkwnbwv work wr7 be done in nnoordence with applicable provkieom of Ore- Storm 5 P yin(rain Addit.100' _15.00
pnpn Revised Statules Chapters 447 and 6T!and applicable oodes and that Mnhlte"W"SWA 25.00
no help wfs be employed unless licensed under ORS 603.(If elwW from --- -
state reptstratiom Please 17ive reason be". Back flow Prevention
11()AAECIYIRJFFJS-1 hereby oertyy kr!I am the owner of Me property de- Device orAn64NAl lionDevw* _ 7M ---
wxrhed above.M which bcadon 1 propose to make a pkxnbb p InstaKsoon for Any Trap or Waste Not
my own use and fhb property Is not being oon s&ucted Im sale lease or rent Connected to a Fmhwe 750
Catch 8&iln 7.50_
kw.of Edd.PMwMing— 40.00 Per M.
Specialty Requested Insp-dons 40.00 Per K. —
__-- Aker.of Plumbing wMhh — _--- —
an EES isArg Bldg 1S.00 min.
AUT43RI.7FD SKR4ATURE t7de New DWp.or Build.Addition -- --- 26.00 min. --
Bm Glain&Ln le t2ml - -
Descrtbe wof% new(j ed ditton❑ alteration❑ repel❑ tiuel_1' 15.00
IP be tone residential�i nonTesldelHialD — —
Exts&g Cepa of - -- ._---- — ----- --,—� _.
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