13269 SW TAMERA LANE �.
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�g�C�IO NOTICE
city of TLgarA Billdistg [teP—ta'ent
13135 Sir Hall Hive. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Rriei.nens Phone' 639-417,
. Underelab Mech. Rough- ! Appr./Sdwlk
Flbgin
Footing -------- -- n
Gas Line FINAL:
Found. Plby. Top Out
Poet/Beam Struct. sae. sewer
Framing -Bldg.
Poet/Beate Mech. Rain Dra..n
Insulation -Plumb.
Flbg. Underfloor Watar Line Gyp. Bd.
-Hoch.
Date Requested- 511`
'ri.,� T Less t _AM PM
.n.-a.rf'fs' �i1L Permit t
BO Ider:
THE FOLIA-e_ ING Oop-RECT I ON; ARS RRQU I RED: —
Il
inepe,ctors ^✓ Date:---.-•
rkrIT *VED DISAPPROVED — APPROVED SUBJECT TO TROVE
Call Fo- Ruinsp.
N W.61w, FWN W�
F
CtTY F YtGrARD MECHANIC�'L
CITYOFTWARDPf--.RM I T
COMMUNrrY DE,fELOPMEY- r DEPARTMENT ''ERMIT #. . . . . . . :
111258WHWiBlvd. p.0 BcXM
97-TkJwxl,OnOgOn 97223(603)&39-4176
7t�l DATE IS3SUEr)- 04/13/92
iITE ADDRESS. . . : 13260 SW TAME R0 LN PARCEL: IS1331)C-14700
AJBD I V IS I ON. . . . VIL.LAGE AT SUMMER I.AKE V-!ARK ZONTNGC R- 11
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . 32
CLASS OF' WORK. . 'NEW FLOOR FURN. . . . .- EVAP COOLERS:
TYPE OF USE. . . . :SF UNIT HE . - VEN"r FANS. . . -
OCCUPANCY GA -'. . :P3 VENTS W/o APPI-g VENT SYSTEMS:
STOP I E=ra'. . . . . . . . . BOIL.FPS/r-nMpRESSORS HOODS. . . . . . . :
(:"LJEL 0-3 1-4p.
DOMES. INCfN:
MAX INPUT3-1 HP. . . . COMML. INC11:
DAM :PE RS?. . BTU 5
1 -30 HP. . . . REPAIR UNITS:
ETRE`
GAS PRESSURE. 30-50 HP. . . . - WOODSTOVES, . -
NO. OF so+ HP. . . . : CLO DRYERS. . .-
FURN ( 10OR n-r!ig AIR HANDLING7 UNITS OTHER UNITS.
<= 10000 cfm: l GAS OUTLETS.
FURN ) =iqiol-� BTU: 10000 c f m:
RICK PEl-ERS014 F'EES
type amokint by date r,er-pt
13L'69 SW TAME RA LN
25. 00 NL 1 04/13/9c-,
1 I(iAr(l) ON 97234 1. -25 BLT 0411319L
Phone #-
r."Ontt-ar-tot—
F')IR PRO FEATERGPPl) A ' --
SE POWELL
)'CJRTLAND OR )7
Pf-q 7.L-1066 26. 25 'TOTAL
------ - RUUl
nus Permit is issued subject :0 the regulationscontained in the Final -Ins'pEectiREonD INSPkL-f (ONS
-----
Tigard Municipal Code, Stat: n# Ore. 5PPcialty C61es and all other
applicable iaws. Ali work will be done in accordance with
approved Lians, This permit "ili expire if work is not started
within 188 days of issuance, or if work is suspended ter tore
than 18@ jays,
!-'ev'Mittpe Signator-es
I sued By ,
Call for inspect ion 639-6t75
CITY OF" TIGARD RECEIPT OF ;--f4YMrNT RECEIPT NO. a92—tic 5963
CHECK AMOUNT a P6. 25
NAME a AIR PRO HTG. & A- C'- t INC. ("ASH AMOUNT a 0. 00
W)DRESS a 6303 'GE POWELL BLVD. PAYMENT DATE a 04.' 13-/9 iR
S U B D I V I B 10N
POR1-LAND, OR 97;206---,
PURP(?fjF OV PAYMENT AMOUNT PAID PURPOSE. OF POYMENT AMCUN't r.'n 11)
MECHANICAL_ PF MFC9P---0'dk .2Z. 00 sT. BUILD Pt!-.'R 1. 25
3269 SJ TAMERA LPNE
JOTAL OMOUNT PAID 6. .:'S
X
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INSPECTION NOTICE
City of Tigard Building Department
F.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
r^
Type of Inspection .__ KE ' `U`",//
Date Requested � Time`_L A.M._ P.M.
Address/_sL� LPermit #. a�1(
Owner C ,�y� Lot #t
Builder�-- / �_I�YL A, (_t&�
The following Building Code deficiencies are required to be oorreeted:
- ---PC) j c'Szq '�crr+LonJ 97119
_R -,�s _ N, PC
---
ID 7 b --.- -
Presented to� _ P-Approved
Inspector , I _ ❑ Dlsepproved
Date Z0__5_ �d
CALL FOR REINSPECTION
❑ YE$ ❑ NO
11 ■ �I
� � lA �d ■
INSPECTION NOTICE
City of Tigard Building Department
P O. Box 2397
Tigard, Oregon 97223
Phone: E,39-4175
Type of Inspection
Date Requested__._..__._ � � Time A rA.—.��P.M.
Address j_�'- 11 .4:1'-Y'1 Ci- Permit #
oLl
Owner nn nn ^^ _ Lot # _
Builder
The following Bu'Iding Co defie'� - required to he corrected:
-.,P,
'0'*
'T11k 4 .111/1,--6
Ct
�Oci ��^I
� C'c� .1111►�-�� (�ir�r � .S�d��__
Presented to _. ❑ Approved
Inspector roved
Date r
CALL FOR'YBRiSPECTION
ES ❑ No
errerre rr�ra sr■errlrr■r■r� MISSION
�,�1(�M,w,r � INSPECTION NOTICE
Urn"
DCity of Tigard Building Department
12420 S.W.Main St. `\
Tigard,Oregon 97223
Phone: 63941`71
Type of Inspection _ ��LC )a.4 - _
Date Requestedz �� _ Time A.M. P.M.
Address /J`1�5a_!_— �1 C&2r2nC.?-C �)"l. Permit
Owner _-- -- J Lot # --
Builder _ 17(1� 1tLi k ��f/ _ _�ra�l - f�f b �s_
The following Building Code deficiencies are required to be corrected:
Presented to _ U Approved
Inspector ❑ Disapproved
Oats
CALL FOR REINSPECTION
❑ YES 0 NO
mr, ML
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection --
Date Requested____ — Time_— A.M.. .—P.M.C(�(
Address "3 _L—. �__ ' �c Y --- Permit
Owner _ �__—� (_� _ Lot #
Builder A _
The following Building Code deficiencies are required to be corrected:
Presented to -- ed
Inspector ii7t ___ —_ ' I Disapproved
IF
Date ��►�..�°"" —
CALL FOR REINSPECTION
❑ YES 0 NO
I
INSPECTION NOTICE
City of Tigard Buildinq Department
P.O. Box 23397
Tigard, Oregon 97223
Phone-f1$9-4175
' f>
Typ of Inspection —
Date Requested �V – TIMg _ A.M._ P.M.
6 , L Permit #�`"�
Address
Owntr _ J 1 L Y1 _ Lot # _
Builder
The following Building Code deficiencies are required to be corrected:
Present4to 44pproved
InspectU Disapproved
i —
r
Date
CALL FOP. REINSPECTION
[] YES O NO
IN;PECTION NOTICE
City of Tigard Building DE 3rtment / l
P.O. Box 23397 f
Tigard, Oregon 97223
Phone: 639-4175
Type of inspection o-y-, �—
Date Requested r 30 Time A.M. � P.M. /
Address Z-52(02
L �7!' V' Permit # 0 lit
Owner Lot #
Builder
The following Buildln� Cede defir,;encies are required to be corrected:
Presented to .�
—_ [4--Approved
Inspector _ _ _
[� Disapproved
Date '!
CALL FOR REINSPECTION
❑ YES ❑ NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone:
6//113/,9-4175 yy
Type of Inspection __ d,122�
�Sd.SJX.�. _–__—
Date Req-.jested �
ested / /QTY 9'1Y4' Time A.M. _P.M. i9
Address /� [�'/ f�. � Permit #�
Owner -- — _--__ -- Lot ____---
Builder
The following Building Code deficiencies are required to be. corrected:
Presented to __— __— Approved
Inspector _ ( Pproved
---- � _�
Date _
CALL FOR REINSPECTION
Aa-�Fs 0 NO
Mai
INSPECTION NOTICE
Cid of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
v '
type of Inspection
/ 7 _-
Date Requested___ U !v2 _ Time _ A.M. .x P.M.
lJp
Address — ,e?6 yT�9'1</ Permit #
Owner _ sign= Lot #_
Builder�
The following Building Code deficiencies are required to be corrected:
Alnrl- - r ----
Presented to ,►pproved
Inspectnr ❑ Disapproved
Date
CALL FOP. REINSPECTION
F1 YES )<NO
s,
INSPECTION_NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested Time A.M. P.M.
Address r__1.L�Ll1.L i �( Permit # a [ X
Owner — Lot #
Builder
The following Building Code deficiencies are required to be corrected.
I
_ I
Presented to -_ ❑ Approved
Inspector _ [_� Disapp'-oved
Date —
CALL FOR REINSPECTION
❑ YH ❑ NO
I
PLUMB ING FIE RM)''T
CITY QF TIGA RD NO . : V1 881.049
CIIYOFWAPD DATE 1:3 a
COMMUNITY DEVELOPMENT DEPARTMENT OREGON PPI.M. 1:11141'r .NO . 001040
13125 S.W.Hall Filvd.,P.O.Box 23397,Tigard,Oregon 97221(503;639-4175
—7JnTr-?VM3T7-r-)T) : 1 .5P-6Y 5W
'TAX MAW/L(:),r 1.51. 3.500. 1/11700 501:: 0 !:JJMM[.-J41 nKF: PARK L..T ! 2 DK :
I-AND USE: p4 . .5p1)
I
NO: N(*.)
WORK CI-ASS : NEW WAITH'.14 T 3 'TRAP
USE *TYPE : GTN(*.,*L.E-: F'AMJI- r` (.11::!TNAI. 010:1-011411 PPVN*T'P
CONSI . 1'YU'E; VN I .A1.10RAII.My 3 I'Mr-', PRYMEP
OCICUP . Gpp . : 1:43 TI. D 511-40WEP rPAPS
DYSiHWASHER
GAPE'W',E. DT5POEiAI-- 1.
NO . 5 TORIES; P WA51-I.I.W., MACHINE :1,
DWEL.L .UNT'r5 : I I AUNDP'Y MAY IXWEN MIA
V-LOOP DRAIN
SINK 1. 5EWUP (F-T)
WA'T[-.:P HE-.:AI*E:P I G'TOWM/PATIN (F'I* I.
PF.M0V4K5
MURISSE-11S DON PEPM11' $ 1.3�2 "50
P(3 Box 1.9!"Ji-14
W
N part 1 a ri d ur 97219
(5031 ':OWTE 'T'AX *6. 63
rt
0 T I-lE*R
C H(')1--.MAKE'r4 HAMM-11
() I 1:11-10EMOKEP I S PI U11*1181 W."
N pts BOX E250
T
9LZ()2.'�
M t In c:*1,(119. c1 r
C A PHONE ( "303) 630-772113
T NO . 39e2 'T01 AL..: 111111139 1.3
0
R
PE,.(7r--,Ip*T, NO.
This permit is issued subject to the regulations contained in Title 14 TNSPECIJONS
of the TMC. State of Oregon Specialty Codes,zoning regulations 1:*.11-8 .UNir)C.,RSiI AH
and all other applicable codes and ordinances, and it is hereby PO!'51, a BEAM
agreed that the work will be done in accordance with the plans and
specifications and in compliance with all applicable codes and WA'1'1*-.P I...'INE
ordinances The issuance of this permit does not waive restrictive 11-1-8. TOPOU'T'
covenants Contractor and subcontractors shall have current city PAIN Dl".AINS
business tax permits.This permit will expire and become null and FT NAL..
void it 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
ill requir specticitis are requeste nd approved
sp
Permitt ,i -fllire [AAI I FOP TN5PF-C1'1ON 639 A1 7 5
f1v
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
ML('.,I--IANJ.CAL- PERMIT
PERMUT, NO. : ME801050
CITY OF TINA RD (�CllrY0—F inGARV DA"IF 'I'LiSULD 6/30/88
—
COMMUNITY DEVELOPMENT DEPARTMENT 0*10ow V,Wl M I'-,M'f . NO C-1 0 t 0 48
13125 S W.Hall Blvd..P.O.Box 23397.Tigard.Oregon 97223.(503)6394175
:17,3269 GW
TAX M(•P 11-01, 33L)(:; :1 ,1700 SUI:i : V1.1-1-AGF. (il "iUMMEPLAKE WALK L.T : 2 8K :
I. ANI) LJI:)I:-:' : 1:i.q
I ILIT tl:l,z[;,
.1*T EM NO NO
WORK GLAS)S : Nl::,W F:*I.JPNAC,E <11.00K AIR I-IANDL.R <16
USE TYPE : !i:I*N(;L..I::' I-*'AMTI...'Y FURNACE 3.001<+ 1. AIA HANDLP 1.014
CONST . TYPE- : VN 1::*I...(:)()W FtJPNA( E r.::VAP , C.00LEP
OCCUP.GRP. R:3 HEATER VEN'T' FAN
V r-.:N T VEN'T . SY51 EM
BLR/COMP <31-11P FIO(:)I:) I
NO. S1 OAT E.5 P SLA/ramp 3-1151-4P T Ne 1.NILKPA"I'OP(DOM
DWELL .UNT.'1*!.i : 1. 111 P/C OMP J.5-30HP 1NC1NUPA'T*OR(COM
F UEL. 1*yPIk-.. GAS 91...8/cOMP 30-501-AP PEPA:Irl UNI'll'S,
MAX . INPUT HLI:',,/COMP 504-1-11" O'I'Hl::'P
FJPE DMPR5 ? GAL, P'.1J."NC: Ourl..111,1.i I.
I IJ:GH PRESS'?
L-Ow
M0P1S5E'T'TI" I.)ON I:+:.,PM T Y* 111 1.0 . 0
0 P D 0 X 1.95 2 4 PLAN Pk�.VTEW 4i 1:1 2!")
W
N p ci r t 1.ia ri(I or 'x'721.9 FJ.XJ U PE'c5 1;3:'.5 . 00
E PHONE (503) 'PATI 931./1 5 TATE *TAX 412 Pi 1.)
R
C
0; DELI HEAl'ING 3:NC .
N 11555015E PIAZZA AVE
T
R c,3.ate kniamt; or 19701-5
C A PHONF. (503) P-413-11,841
T NO. 4-17 U I AL: U .
0
R
PECIFTIDT NO.
............... 2-:J
This permit is issued subject to the regulations contained in Title 14 f:*4I,.-*.:(41.J.I:r-;lE---J) I:Nr3PE(-,fT0NG
of the TMC. State of Oregon Specialty Codes. zoning regulations I I NI:::
and all other applIcable codes and ordinances. and It Is hereby P05T FIFAM
agreed that the work will be done in accordance with the plans and
specifications and In compliance with all Applicable codes and MLKA-4 XN
oro'nances. The issuance of this permit does not waive restrictive I- :LNAL.
covenants. Contractor and subcontractors shall have current city
businass tax permits This permit will expire and become null and
void if foork is not started within 180 days.or f work is suspended or
Abandoned for a period of 180 days any time after work has
comme n I be the responsibility of the permittee to 85SUre
_TK shall
que
, �ts
all req,jl I r d in ecLums are reque d approved.
Permititge, ature
CALL F('.)R 11SISPECTION 639-11175
Issued By
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
C'TYOFTIGARD BU I I D I INIC-1 1:-�E PM X T
j:)j:-.kMI'T NO. 13U081.040 Crd�-\ARD
YOFW
COMMUNITY DEVELOPMENT DEPARTMENT 02160N
'3125 SO Hall Blvd-P O.Box 23397,Tigard,Oregon 97223.(503)639-4175 PI-4101 I-'M I .NO 0131.0 418
JOR 1.3269 1561 I'AMF.::PA I N
11))" MAP/1-01 1.511. 330C 14700 5110 : V11 L.AGL. A I 'A.)MMEN1 AKL PARK I T V BI(
I (INI) tISF P/1 ::5P1)
I 0I !i T Z fn� VAI..UAIA:()N t1i 115-7 , 151. S)1:.:.T 6AC K S
FF,IONT : 20 REAP: 5
WORK CLASS : NIL-.W DWE'Ll... .UNT I'S : :1. LL F F : 5 PIGI-11* : 44
USE TYPE : SING11-1:1 FAMII .Y NO. DFKDROOMS : 3 LX I WAL I
CONST TYPI:--,: VN NO. BATH!';; 3 N Si W
0('.1CUP GAP . P3 1:'-'P 0 Y OPLN I'NGS
OC XUP LOAD N 5 E W
APL.A : 3198
N6. ST 0 P I I".G 2 1.SJ* 1.149 ROOF C(*)INST C FIRE PET"?
HEIGHT P.0 1?N U) 20,9 APFA !-5 Fi':P A P 7 PATE-:1):
BASEMEN-1-7 (:)C CUP SEPAP7 QATED :
ME:2 ZAN TNE 7 PASEM IT
F'L-00114 I OAD: 40 G,%P,%- E 4410 FIRE. 5PI-4110 P"? ALARM7
FLOW DF'-'T'F--'CT'? YES
TYPE- GAS HDCP.ACCESS7 COPRI?
PI-AN CHECK BY : l"It
REMARKS :
PEJS!A-Jf--' OF' NO .
LAST REISSUE
mop I S S E::.T.,l r--- DON PE14MIT 11111115 -28 00
W
N p Cl BOX 19,52.1 PLAN REVIEW $343 ;?0
E p(31-t1and 13 r, 97219 FIRE DEPT
(503) t2/114-9314 STATE TAX 1111126 . 40
OTHER
C UE-VELOPMENT CHARGES :
0 MORI SSE TTE DON sD(,,its ronm) $850 . 00
N UON MURISSE-1111. B0-rL.r.)E,'Ps INC' . SICCA S1 REET) $600 . 00
T
R pa BOX :1.5115 •`4 PDC 4*1. 1111250 . 00
A p o i L1.at ri d r3r. 97p1'� PREPAID < $100 . 00)
C
T PHONE 11503) 2414-9'314
0 PF-.X,':I:STPA1 ION NO. 3~)5;3':3I 11 097 . 60
R I
This permit is issued subject to the regulations conNuned in Title 14 PLC.E I.P,.t--No .
of the TMC. State of Oregon Specialty Codes, zoning regulations PEQUTPE-11) INSPECTION9i
and all other applicable codes and ordinances, and it is hereby FOOTING A
agreed that the work will be done In accordance with the plans and
specifications and in compliance with all applicable codes and FOUNDATION WALL. PAIN DRAINS
ordinances The issuance of this permit does not waive restrictive P01-i'1 & RE-AM WAI EFS L 1.NE
covenants Contractor and subcontractors shall have current city PLB .UNIX.E.P!1LAB (,.11,1*y APPPCH/Sw
business tax permits This permit will expire and become null and 1-1 L AD VIA NAI
void it work is not started within 180 days,or If work is suspeAded or PI s , TaPcwr
abandoned for a period of 180 days any time after work has
c,j,nmenced It shall be the responsibility of the permittee to assure F.RAMI NG
pit required ' spections are requested nd approved F I RE Pill ACE
GAE; L T:NE
INSULA r TON
GYP 1310ARD
Pprmitt Si attire
Issued By7 '� GAII-6
FOR—INSP ION 639 At FS
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
-MI,'I' NO E .1105 1
1)A IT*.: :i:1 31S 1.JW 6/Z5 0/C30
C'TY 0 T 1,15,A4 RDD Pi P I H. r-:1MT . . E 18 1.()41 C I
I-ITY
COMMUNITY DEVELOPMENT DEPARTMENT
t4124 LKA NUMSEP: 03590,5
AW
X MFJJ-1/I.-%.)I -...,.. 75OKL. FIARK R
I AND USE : P/I . 15PI.)
LATT !ii TZE. :
GECTUON : 3-:5 1 W 1::,: 1.IN FMG, : 1.w
WORK ('11 AG 5 : NEW
USE T*ypl*-- : GiNGLE 1=AM11 Y
Ilion, ingi,iNiem tl'.) c:-:JMP1.y With atil I'Lllellfl Rricl
1:iO.Wel"111.11" Aijenc."A rl-iira pcer-mit, *ixpir—w 120 CIM-41B ft"C'm thee (lattim. is%t.lsod , T'hor) t(.-)ta,L
all"C1(.111t will 1:)(-h :I.•P th'" p*wrnlit. Th m Aqj1.*-1I*)c:y claella nut, gli.imi.....
11t.1-1tor" 0,10 43-jr tl-ave 1.inutt:l (an (:).[, thf,,? Illicisp ti-io inewer, is
fJJV(,D6-1 , th'61 1011-1110.1 #0 t i r)
frclm Ll-lf.D (I'l.tit t'atricn(e 4111.Vfi.*I-I . 112 11(a t. M(:) lac^at,te(J , th4e irats t.atller- nihirL3.3.
al-ItJ I'lle Aqjq.IIJ(.Ly W.I.] iiiiIii,m].1 at
iNSTAL.L. ryr,�-, : BUT I 1'.):[N(.', Si -:WEE JM;::,I;-PV1(A.J!i AF411n,Y)
:)WEA-11-I W., UN 3:T S 1.
140'. CW 61DGEi .
It 118H I W,419-re. MON UU
a Box 1.95P-4 ('N'.11NNEA."I'1014 (:,HAPCvr-.: $1. 1.0() . 00
la 1:1 r,t)a III car 97PIN LINE TAP IN51A1_.L .
N PHONE (503) 241,e4-93141
011 11E.P 111*360 00
ra
HONIA05E.-I If-*.' DON
DON 19TTrTT-rj!:iL I TT:. BUI.L.A.)ERS .. ---
C
0 1:)o FO)x 191"WAI
N r.)c)I-1.1 at n cI cir 97P1.9
T
R r+4('.)N1r. (,150,A) PAA 93 1.A
A T.L)N NG . 3rA-533 to:1. :9;'.f . 00
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R
11EQUTPED TNSPECTION!5
This permit is issued subject to the regulations contained In Title 14 PC)(.JGH--T N
of the TMC. State of Oregon Specialty Codes,zoning regulations"I t* ' '
'
and all other applicable codes and ordinances, and it i s hereby
agreed that the work will be done in accordance with the plans and
specifications and In compliance with all applicable codes and
ordinances. The issuarce of this permit does not waive restrictive
covenants Contractcr 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
commencA It shall be the responsibility of the permittee to assure
all rpquid q Pctlons a ested and approved.
Permot,,, nature f',I. L. F0111 xNsjj:,F-'c,r.'E0N 639-4175
Issued By
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
CITY OF TWA RD � PLAN CHECK APPLICAI'IggN
PLAN CHECK #
WYOFTIGARD PERMIT N —
COMMUMTY DEVELOPMENT DEPARTMENT OREGON DATE ISSUED
19125 SW Hdl Blvd. P.O.Box 23397,Tgerd•O"Von 97223(503)89D-4176
JOB ADDRESS _L17_(_ `! _( ���. L��' _ TAX MAP/LOT _ N
SUB: �A_Lk;�Cxu 0 i SS.gtiincil CA(< ;lr�l�. LOT: - LAND USE: _
VALUATION:
OWNER SPECIAL NOTES
NAME: l t7 `S,k rry ALI-S ` REISSUE OF: _
ADDRESS: y— u G I LAST REISSUE_
Laz Ott C` l2 2 FLOOD PLAIN/
SENSITIVE LAND:
PHONE: — 'Zq4-c, _Ll L -
7 APPROVALS REQUIRED
CONTRACTOR PLANNING:
NAME: ENGINEERING:
ADDRESS: _ ^_ FIRE DEPT
OTHER:
PHONE: —_ _ ITEMS REQUIRED
LIST/SUBCONTRACTORS:
ARCH/ENGINEER BUS TAX:
NAME: _ CALCULATIONS: _—
ADDRESS: — TRUSS DETAILS:
PARKING PLAN:
LANDSCAPE PLAN: _
PHONE: _ OTHER: —
COMMENTS:
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
UCS 10--432 00 Building Permit Fees ��.u� �5_,Y,�0
Yf10-431 00 Plumbing Permit Fees _, o?SU /jz,-50
5 0 10--431 01 Mochanical Permit Fees u� _ �S ''D
10--230 01 State Building Tax (5%) 3
Building _ C�
Plumbing _
Mech
10-433 00 Plans Check f ep 35�f� �� L/,2 _
Bu,id
Plumbing _
Mech 11 , 25
30-443 00 Sewer Connection (20X) T ;2.,)-V
V 5 30 202 00 Sewer Connection (80%) R- 9471
30-444 00 Sewer, Inspection 31 _ .3
51•-440 00 Street System Dev Charge (SDC) �_U� —� _[lou _
52--449 01 Parks I System Dev Charge (PUC) vV-5
52--449 02 Parks II System Dev Charge (PDC)
31-450 00 Storm Drainage Syst Dev Chrg (`S1 C)
10--230 09 1 RFD (95%)
10-435 00 JRFD (5%)
10-230 06 Washington County Fire #1 (95X)
10-435 00 Washington County Fire #1 (5%) _
1 -2 2.0 00 nma r t/Wodwoud
J TOTAL D,1 , s 9c►.�3
REC 11
APPLICANT SIGNAL URF:
Received By: Date Received:
ht