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14600 SW 72ND AVENUE FILE NO. 72ND AVE. - 14600 STR. OPN. PEWlIT APPLICATION -- STREET IMPR+ ':McNT/EXCAVATION C PY TO: :WHITE) - FILE ORDINr, aCE NO. 74-14 )IYELLOWI INSP. AGt7�V (INSTRUCTIONS ON SEPARATE SHEET) :PINK) APPLICANT APPROVED )!§J APPLICATION NO.: Z'5 3 NOT APPROVED ❑ CITY OF TIGARD, OREGON FEE AMT.: S 2Z1 010 PENDING FEE. PMT. ❑ CITN' HALL RECEIPT A?Z30 PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENTeY ._- 2ATE /O //7 PENDING AGENCY ' OK" p Application and Progress Record MAINTENANCE BON,Ap M PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED iK] ANNUAL ❑ PENDING VARIANCE ❑ EXPIRATION DJ�T Zr PERMIT NO.: 224—I::� DATE ISSUED: _I ��"�L �� BY: - (1) APPLICATION IS HEEBY MADE TO EXCAVATE FOR AND INSTALL _ _ . u : �{ _f-_�✓eu• _ "+ AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS. APPLICANT �_ -� 4 'I-1 �•►�I' /��� \ \�c- _� lGt7I'���� n�NA ADDRf55 l CITY PHONE CONTRACTOR_+ +.I ~�IZ � LrCC -��QCUc _ -1-L 0 NAME ADDRESS CITY PH9 PLANS BY__r�lA Nt, __. L�T`�O :U�1�1 ��+,.r . (1 _ _ --? 3A NAME ADDRESS CITY PHONE ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ S' — DOLLARS (1) EXCAVATION DATA: FOR OFFICE USK. ft—C, ----ru[)MIN. 0.04X • E�()0. .t— -- STREET _ DESCRIPTION PROGRESS & INSPECTION STATUS _ NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY TYPE LENGTH WIDTH DEPTH ITEM A QUANTITY STREET -- --T --- OPENED — -- P :NSP G 744 :J (' _ P- 1 R TION E — -- Q -- U —-- -- ESTIMATED STREET OPENING DATE Ny,i—L_ 1 Z / �'ri _ g ESTIMATED STREET CLOSING DATE: _�._Il��.J 20 / �� E 'tr STREET (3) SECURITY NO. �SECURITY 4MT.: S CLOSED —�^ SURETY CO.: �.c�rzvt'�cy J ��O a• r\,� FINAL CE_R_TIF_I[D CHECK U _ CASH ❑ SOND-W, INSPEC. (Q) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS f CONDITIONS: FEATURES; EXCAVATION LOCATION AND EXTENT. 1 1 � 1 1 CURB - �� - - _ _ �� ♦ - 1G 1 I I 1 (5) NOTE THE CITY OF TIGARD DOES NOT, HERESY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORN WHERE RIGHT OF WAY JURISDICTION IS THAT OF WASHINGTON COUNTY CIA THE STATE OF OREGON THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND CONSTRUCTIOII SPECIFICATIONS PERT HENT TO CONDUCT OF THE WORK. AND TO SAVE HARMLESS THE CITY AND EMPLOYEES AGAINST ANY INJUR O AMAGE HICH MAY RESULT FROM APPLICANTS ACTIONS. APPLICANTS SIGNATOR _ DATE ,� PLEASE TAKE THIS TO THE CASHIER FOR A RECEIPT 11 f NAME: �a1n�� �c DATE: _ I I -1 - r� ACCT. # QFSG)tPTI0N r AM04JNT 1.0-220 Refundable Performance Bond Deposit s 10-435 Sign Permits _ HOP TU _ $ 10-436 Public Sewer Plan Check/Inspection Fee $ _ 10-436 Public Storm Plan Check/Inspection Fee _ $ 10-436 Street Dedication/Public Improvement Fee $ 10-436 Stre,at Opening Permit 10--437 Subcaivision Applications: S MLP 10--440 Zoning Applications: Z(', CPA 7.OA PD SDR Misc SGE Cu SLP V Z 21_442 `3traet Light Fee _ S 10--451 Documont Sales: Engrg. Planning Bldg, s _ 10-451 Street and Traffic Signs 1+t TOTAL s � (1045P) CI 1rfOFTIGARD No 8230 12755 S.W ASM P.O.BOX 23397 TIGARD.OR 97223 Name Address _. - - --- block Lot lMap SubdivirronlAddrPss y___ piumh Cash' Check Permit p's Bldg Sewer Other Other Rec. By i ! _ Descnptlon Amount Acct No _ -- 10432 Building Per 10 431 f,00 Plumbing P-- 10.431691 -10431601_ Mechanr(.& _ - - 10-230501State Bldg 10-433 , Plans Check r 30-443 - -Sewer Conne,.lion 30-444 Sewer Inspection 51.44$ Siroet Syst Dev Charge _52_449.610- Park'; I Sym Dev Charge 52 449 620 P,irk , II 5ys1 Dev Charge 31450 stiunr D4iuragr 5y ,t Ucw CharUc' 10 430 F3u;ine; . Ta, jp 434 Alarm Permit - 10 227 Bail — I.0 4Y) Fines TraffLcfMisdlParkinIq - 1023() CPTA TrafhciWidlVrc Asst 10456 - -Indigent Delrnse - —_r_ _ 30 122.401 Sewer SenicelUS 30 122.402 Sewer ServicelClt 30 123-- Sewer Si-vfcelClty Maint__ -- - --- ._ 30 t25! Unmatched -- -- 31.124 Storm ra nage _ -•--- - --- 4 ancro t rin ymf t _ ancroit Intl Ymt -- - - - MAL QEP?. /D-I 7-c4S- SAJFoRMGf--) QPM/fi&"'r--' T/f1VT' VAJDt:e IVO r G-/,2CVMST1�NCd WOULD WE /� � 77fE pA,ek1AjG Lars /ZVAIOF/r rms- 7AAr 1aelvE u�r�Y/D.2i ve c�.�7 y' Az',WA!/ I Urro 7J5�E sr t 7•'I 1C iA.►y MvsT !3� ttxArC� rD P/C.0•uP 77yE 40,s7EX &67v "' SlJCN G�GURE"S ..GF OTJ' Z�uJ/SE /7- u//L L /bilk• v~-!v d6- R�cAt,tST.zG�I'�fl x2e AEZCA:�.oI � ©/f! MOAK- C8,s. C-W 77iF6r LpT 40'.C4 4wvL= m de, A sv4oe Acb WOQG" .Qe4-9 6t7P-f7'a-)e4 r' Oe Wh,'#rX 4W 70 P,1eELe7VT slXN M!!STOle A407- r z v 0 a o a Q C� o z ;n z N � M LL!!AA w QZ F•O H FZ Zw p¢ a � O J I� z O O0 i a a u ¢ 0 O ri) O g ¢ O > c7 a _ N C7 C� -6n { 0 v N � J U � 0 T iL) N Q.. O P. L Z N O O F4 � O U +-) -:J. Z H U w Go Uw lL }Ll f` O U) H Z U `f W tu � (ICoa (A u `'lt T � co 6 , LA us All r , > , Q I ,r` 41� •3 I �LL i , ?1 - ell All I .• � 31 Ifmom I 62 r� �2► `N £Y ti t- o T s 'z i � I J _ 'j gal s! ; jo �J ,fit Q1 d ti 1p X34 i t tv