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8361 SW DEEANN COURT ADDRESS: V361 - A (:our- i:lrecords\micreflm\targets\buiIding.doc CITY OF TIGA►RD COMMUNITY DEVELOPMENT DEPARTMENT CETT T'--.ICAfE OF 1'3125 SW Hall 6,4d.T19srd,Oregon 97223*8199 (503)GUAM OCCUPANCY X XAX PERMIT #. . . .. . . . l: MST94-0185 x.39-4171 DATE 113SLJED: W07/44 PARCEL SITE ADDRESS- 9 013361 SW TWEANN CT GURVIVISION- - i FINLEY PARK 70NING:R-7 BLOCK. . . . . LOT. . . . . . . . . . . . . n014 l",1..A5'-3 OF WORK. oNEW rYPV OF LISE. . . zSF OCCUP(INCY GRP. i R3 OCCUPANCY LOAD oE23 4 IT"NnNT NAME. . . : Remarks: PATH I Owner JAY MILLE'R P 0 BOX 03291 ITGARD OR 97281 Phone #1 684- 7543 Cantra;ctort BELL. HEATING 15150 9F PInZZA AVE-'.: ('t,(.1CK()MA!3 OR 971I115 Phano #s Rey #. . % 00447 Dc(:,(,tpFknr.y of the above reforenced building is hereby given, and rertifies the compliance with th, State It flregtln Specialty Codpis for the group, or-oupancy, and true imder which th,; referprir.-ed pet-mitissmed w B L fu I I .1PEG"I Op I PN4(Gi, CO)F I C I AL. PGST IN CONSPICUOUS PLACE i INSptiCTION NOTICE City of Tigard Building Departionnt � 13125 811 Hall Blvd. Tigard, Oregon 972231 Inspection Line (Rec-O--Phone): 639-4175 Business Phone: 3 41 Inspections___ Pnoting Plbg. Underalab Mech. Rough-in Appr/Sdwlk Found. Plhg. Top Out Gas Line Ic PI k-,j Poet/Beam Struct. San. Sewer framing , Post/Beam Mach. Rain Drain Insulation ---Plumb. Plbq. Underfloor Water Line �7 Q 1,g(yp. Bd. Date Requested:_ z o / /// / _Timof AN PM Adarone: � 12 "1Permit 1t_���L` Bullae TTI MOLLOWINO CORRECTIONS ARE R6QUlRED: InnpPctor:_ --.-------- Dates — PPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE --__Call For Reinsp. Iffs CTION NCYfICE City of Tigard Building D"wrtment 13125 SM Ball Blvd. Tigard, Oregon 97223 1, In►vaction Lina (Rec-O-Phone)r 639-4175 Business Phone: 4111 Inspections Footing Plbg. Ussderel.ab Hoch. Rough--in Appr/Sdwlk Found. Plbq. Top Out Gas Line FiNALe Post/Beam Struct. San. Saver Framing -Rl.dg. Post/Ream Mach. Rain Drain Insulation -Plumb. Pl,bg. Underfloor Nater LlAio �tlyP. Bd.) -Mech. Date Requestede-ti Times AM _�Q_PM Address: U ._)�l, ldl -(�i�_�L Peruit i:,z'/ Builder: THR FOLLOWING CORRECTIONS ARE REQUIRED: Inspector: Date: i APPROVED DISAPPROVED APPROVED SUBJECT TO Call For Rei.nnp. �N&FECfIO(/ NOTIC4 City of Tigard Bu.11ding Depmrtment 13125 611 Hall Blvd. Tigard, Oregon 97223 Inepection Line (Roc-O-Ohone): 639-4175 Business Phone: 6 Inspect ion s Footing Plbg. Ondarsleb Mch. Rough-4n Appr/Sdwlk Found. Plbg. Top Out (;ae Line FINAL: Post/S,-nm Struct. Ban. Sewer framing -Bldg. Pont/Beam Meech. Rain Drain /Insulation -Plug, -----.___Alww � Mater Line Gyp. Rd. -Hoch. Date Requented,� CJ( �`P l/ T Tim. AN PM Addrdnetl it f1 V 1 flietlder: 7tiR FOI.I.OWIN(, OOPI:RCTIONS ARR RPWIREDs Inspectors _= Date APPROVED DiS"PPROVRD - -- APPROVED 6DBJECT To ABOVE' --Call For Reinsp. awa INSPECTION NOTICE City of Tigard Building Dep vtooat 13125 OW hall Blvd. Tigard, Orogcws 97223 Inapoction Line (Rec-O-Phone)c 639-4175 Buninons Phones 139-4171 Inspection:_­­_._________ rooting PIbg. Underalab Mach. Rough-in Appr/Rdwlk Found. Plbg. Top out Gas Lir.e FINALS Port/Beam .9truct. San. Sower ^ramin -Bldg. rest/Beam Meech. Rain Drain Insulation -Plumb. Plbg. Underfloor. Nater Line �L7�` Gyp. Rd,. _Hach. Date Requested: h Time= AM PM Addrosas L Permit 1:_ Builders THE MOLLOMINO OORRECTIONB ARE REQUIRED: Inspectors pec s ._...__------- nate:� c _1-"1I5PROVED DISAPPkOVED w'- APPROVED SUBJECT TO ABOVE _Call For Retnsp. w INSPECTION NOTICE / City of Tigard Building Department 17125 fM Hall Blvd. Tigard, Oregon 97223 Inspection Ltne (Rec-O-Phone)s 6:9-4175 Business Phone: j3J71 Inspections_ _ ' Footing Plbg. Underslab soh. Rau5 n Appr/Sdwlk Found. Plbg. Top "ut ins FINAL: Poet/Roam Struct. San. Sewer C m n -Bldg. Post/Beam Mech. Rein Drain a Insulation -Plumb. Plbg. Underfloor Water �jLine � Gyp. Rd. N h. Date Regveateds_ � / / Time: �AM __`pM 14 sc Permit THE FOLLOWING CORRECTIONS ARE REQUIRED: Inspecto APPROVED DISAPPROVED PROVED SUB�7ECP TO a ABOVE _MCall For Reinup. sssi IHS€'ECTION,_Ndl'ICE � \\ C}.ty of Ti3ard Building Department 13125 801 Hall Bled. Tigard, Oregon 97223 Inspection Line (Rec-O-Phone): 639-417ti Business ?hone: 639-41.71 inspection: Footinq Plbg. Underslab �Rouqh-in Appr/Sdwik Pound. Plbg, Top Out Gas Line/ FINAL: Post/Beam Struct. Sen. Sewer: rfin i -Bldg. Post/Roam Mech. Rein Drain Insulation -Plumb. Plbg. Underfloor Water Line Gyp. Bd. -Mech. Date Requeeted:_ �y TimP: AM PM c_iJ� Address: Permit BuLl.dert THE FOLLOWING CORRECT27NS ARE REQUIRED: ----------- Inspector: — Date: I � --- . ArvPPROVE\\\D DISAPPROVED —_� APPROVED SUB.JECI' TO A[iOyE � ) _—Call For Reinap• �N�BCTION NOTICE City of Tigard Building Departaeot 13125 ON Hall B1R1_ Tigard, Oregon 977 lnepection Line (Rec-O-Phone): 639-•4175 Ruains,ss P o e 3 4171 Inspection: rooting Plbg. Underelab Noah. Rough-in) Appr/Sdwrlk Pound. Out `, Oaa LlnFINAL: Poet/Ream Stinct• C _Ban. Rawer �r►rssi n�---7 --Bldg. Pust:/noam Hoch. Rain Drain Insulation -Pim, Plbg. Underfloor Nater Line gyp. 6d. -Meth.. Date t,jQu,astedl I - � Timm _� PN Addraes: � �1A*ierait 1, [' —�I S5 ' /P� a C� L Builders__`_ TRE FOLLOWING cORRECTIONS KRE REQUIRIDs vo Al�c --- inspector Date:, . J�z� / APPROVED DIS(,AP/PP_OVVRD_ — APPROVP.n SUBJECT TO ABOVE ` Call Por ReInsp. rl�aaa�laaaaaal ,0Sr KCT I ON NOTA City of Tigard Building Departe"t 13125 SW Ball Blvd_ Tigard, Oregon 97223 Inspection Llne (Rec-O-Phone): 639-4175 Business Phone: 639-4171 Inspection'---- - ---- ----- — Rooting Mg. Underslab\ Hoch. Rough-in Appr/Sdwlk Round. -�lbq. Top Ott l Gas Line nNAL: Post/Ream St.ruct. ban. Sewer -r/ Framing -Bldg. Post/Beam Hoch. Rain Drain Insulation -Plumb. Plhg. Underfloor Water Line Gyp. ad. -Neck. Date Requested:_ b --�i q Tit An pN Address:-<R3(a I y ) Cyl pa ST q y - Q I F5 Builders C>l l w( .A. TNR FOLLOWING CORRECTIONS ARE nRQUIRetDt Inspec:tor:r`__� _ R D DISAPPRCIVRD APFROVHD SU&IECT To ASCWj _Call F.r Reinap. INSPECTION NOTICE Citi of Tigard BuildSng M!part>tent. 1312S OW sa11 Bled. Tigard, Oregon 97223 Inspect!on Line (Rec tPhone 639-4175 Byeineon Phone: 639-4171 Inspection:_ 6�L� Footing Plbg. Underelab Mach. Rough-in Appi'/;r1w1k Pound. Plbg. Top Out Gas Line Post/Ream Struct. San. SOMOSC Framing -Bldg. Post/Ream Mech. Rain Drain Insulation -PIUMb. Plbg. Underfloor ate. Li//sle _ C�Gyp. ad. Date Requesteds (e �`�._ / —T/i�a'�es� p,/AM �c AddrAaes 'n' y // //Pertik/ 1t /7 " �/laS M'I CIL Builders le _ 70 7 - 7 /f� TM FOLLOWI O CORP.ECTIONS ARE REQUIRED: Inspector(:_ —` _ - —— Dates_- 7 U APPROVED DISAPPROVED APPROVED 01BJECT TO ABOVE Carl For Refnap. INSPECTION NOT'LCE City of Tigard Building Departasr_ni. 13125 BW Ball. Blvd. Tigard, OrvKjon 97723 Inspection Lina (Pec-O-Phone: 639-4175 Bueineex Phone: 639-4111 Inspection: --- looting Plbg. Underslab Mech. Rough-in AppL/Sdwlk Found. Plbg. Top Out Gas Line FINAL: et/Beam_ct. San. Sewer !razing -Pldy. at/Beam Mech. Rain Drain Insulation -Plumb. bq. Onderlloor Water Lina Gyp. Bd. -Mach. Date Requestedt -- 7 ' / 7 Timet _ SAM PM Address sn Mr- TM C j- Fermin-f t�� Builders le M , TBE FOLLOWING CORRECTIONS ARE REQUIPED: Inspectort _ _ Date.-Y�) ROVED D23APPROVEDAPPROVED SUBNBO Call For Reinep. 1' SPS ION NOTICS City or Tigard Buildi-nq department 13125 SN gall Blvd. Tigard, Oregop 97223 Inupection Line (Rec-O-Phone): 639-4175 Business Pnone: 639-4171 i Inspection:_ 1zL-CL,L -- Footing Plbq. Unde_alah Mach. Rough-in Appr/Sdwlk Pound. Plbg. Top Chit Gas Line FINAL.: Post/Beam Struct. San. Saver Framing -Bldg. Post/Beam Mech. Rain Drain Insulation -Plumb_ Plhg. Underfloor Nater/Line gyp. Bd. h. Date Requested: lG— ' e // Time i Addreesi_ (D _e l /'� /�L Permit TI:E FOr"WINO CORRECTIONS ARE REQUIRED: I IsG�'Icc ' Qi-� iV� �7(Jo1r7 Inspectors Datel _,_APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE � Call For Reinsp. 1 I INSPECTION NOTI('E / City of Tigard Building Department C J 13125 SR Ball Blvd_ Tigard. Oregon 97223 Inspection Line (Rec-6-Phone): 639-4175 Business Phone: 639-4171 Inspections --- ------------ ing Plbg. Underelab Hoch. Rough-in Appr/Sdwlk Pound. Mg. Top Out Gas Linu FINAL: Post/Seams Struat. San. Sewer Framing -Bldg. Post/Seam Mech. Pain Drain Insulation -Plumb. Plbg. Underfloor Water Line Gyp. Rd. Hoch, Dote Requested la _ %) 7�/ Ti,.00.� VAAM PM Addresn: CQ J,2=C' 4051 n c', Pecroi c7q--e)-IL Bu lldecs �Mi' //e f— 312 G a 4_3 LO n THM FOLLOWING COR.7ECTIONS ARE REQUIRED: Inspector: Date: _APPROVED nlSAPPRJVRI) APPROVED SUBJECT Toon Ar.oVR Call For Reinnp, PLUMPING PEi1M11 CITE( GF TIGARD DATEI ISSUED: • 06/06/9494-0185 COMMUNITY DEVELOPMENT DEPARTMENT 13125 SW Mal Blvd.Tigard,Oregon 97223•6 9 (503)639.4171 PARCEL.: 2S L O :DG-•0:30�c10 SITE (►Lj)RESc . _ 08361 S)W DEr EANN CT SUBDIVISION. . . . : FINLEY PARK ZONING: R-7 BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . :014 CLASS OF WORK. . :IgEW GARBAGE DISPOSALS. . : 1 TYPE OF USE. . . . :SF WASHING MACH. . . . . . . : 1 BACKFLOW PREVNTRS. . ie, C, CUPANCY GRP. . -R3 FLOOR DRAINS. . . . . . . :0 TROPS. . . . . . . . . . . . . . :0 STORIES. . . . . . . . :2 WATER HEATERS. . . . . . : 1 CATCH BASINS. . . . . . . :0 F 1XTUREa--- _._.__.._ LAUNDRY TRAYS. . . . . . : 1 GF RAIN DRAINS. . . . . : 1 SINKS. . . . . . . . . . .. i GREASE TRAPS. . . . . . . .0 LAVATORIES. . . . . .4 GTHEER FIXTURErS. . . . :0 TU:B/L-1HOWERS. . . . : SEWER LINE: (ft) . . . . :0 WATER CLOSE.TS. . :3 WAl LR LINE (ft ) . . . . : 100 PTSHWASHERS. . . . : 1 RAIN DRAIN (ft) . . . . :0 Remarks : PATH I OWNER JAY MILLER TIF 4 1520. 00 SW 06/06/94 - P U BOX 2;:3:-'.91 BPRT $ 440. 50 SW 06/06/94 - BPLC $ 50. 011, SW 05/10/94 134-i?mac^.213 1 1.i.iARD OR 9 7281 B5PC $ 2,2. 013 SW 0b/Fr6/94 - Rhone M: b84•-754. SSDC $ `80. 00 SW 06/06/94 - PARK $ 500. 00 SW 06/06/94 - Pl!..im5ing Contras_tar.- --__._...__._...- ._.___.__._..__ MPRT $ 45. 00 SW 06/0E^/94 - MPLC $ 11. 25 SW 06/06/94 - Name: M5PC $ 2. 25 SW 06/06/94 OdcIvIegs: _ _ _ _ PPRT $ 155. 00 SW 06/06/94 - City: _ W _ _ 5t ate : _ PSPC: $ 7, 75 SW 06/06/94 - Zips _ _Phone#:_ Reg #1 --- _--- REQUIRED INSPECTIONS This permit is issued sl.tb.jert to the req ulations contained in the Tiqard Municipal Foot/found Insp Rain drain lv:sp Code, State of Ore. Specialty Codes and all Post/Beam 5truct Water Line InsE. other applicable laws. All work will be done Post/Beam Mechan Appr/Sdwlk Insp in accordance with approved plans. Fhis Vllm/undslab Insp Mechanical Final permit will expire if work is not started PLM/Underfloor Plumb Final within 180 days of issuance, or i4' work i.s iYiechanical Insp building Final suspended for more than 180 days. Plumb Top Out Erosion Control Framing Insp Crawl Drain F=ireplace Insp Gas Line Insp Insulation Insp Gyp Board Insp c.0 horized Contractor Signature Lall for inspection - 639-4175 Contractor Notes : PRMI CITY OF TIGARD PERMI! #ER. . ... . : TMST94-0185 COMMUNITY DEVELOPMENT Dk0ARt IT DATE ISSUED: 06/06/94 13125 SW Hall Blvd.,rigard,Oregon 97223.6169 (503)639-4171 F'f RtA-L: :."n l 0 DD-0.3000 Sl TE ADDRESS. . . : 08361 SW DEf_.ANN C,T SUBDIVISION. . . . : FINLEY PARK 7.ONING: R-7 BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . .014 ___._.___.____....._.___--•--_�----_-._-__-- BUILDING ----_._.____._____ _..._--------...-.-•----________. REISSUE:IIST93--9564 DWELLING UN 1 TS: 1 BASEMENT. . . . . . . . :0 sf CLASS OF WORK. :NEW BEDRMS:3 BATHS:3 GARAGE. . . . . . . . . . :453 sf TYPE OF USE. . . :SF FLOOR AREAS—_---_— - REQUIRED TYPE OF CONST. s 5N F I RS'f. . . . : 1234 sf LEFT. . : 10 ft R I GHT. :8 ft OCCUPANCY CR^. :R3 SECOND. . . :810 sf FRONf. .20 ft REAR. . :P1 ft STORIES. . . . . . :2 THIRD. . . . :0 sf HEIGHT. . . . . . . . :23 ft TOTAL.- -- ---:2044 sf SMOKE DETECTORS. :Y FLOOR LOAD. . . . : 40 p s f VALUE. . . . . :: 102178 PARKING SPACES. . : 1 Remarks : Pf0 H ------------------------------------ PLUMBING SINKS. ., . . . . . . . . : 1 FLOOR DRAINS. . . . :0 BACKF'LUW r'REVNTRS. . :0 LAVATORIES. . . . . :4 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . :0 T(1B/SHOWERS. . . . :3 LAUNDRY TRAYS. . . : 1 CATCH BASING. . . . . . . :0 WATER CLOSETS. . :3 SEWER LINE ( ft ) . :VI GREASE TRAPS. . . . . . . :0 DISHWASHERS. . . . : 1. WATER I.-INE (ft ) . : 100 OTHER FIXTURES. . . . . :0 GPRBAGE DISP. . . : 1 RAIN DRAIN (ft) . :O WPS14I NG MACH. . . : 1. SF' RAIN DPA T NS. . : 1 MECHANICAL --- _.______.__----.._____________._.__ FLES FUEL TYPES------------- UNIT HTRS. . :O! type atm(ii-int by date recpt /GPS1 VENTS . . . . . :0 TIF $ 1520. 00 SW 06/06/94 — MAX INPUT.-0 BTU VENT FANS. . :+ BPRT $ 440. 50 SW 06/016/94 — FURN ( 100K . . :0 HOODS. . . . . . : 1 SPLC $ 50. 00 SW 05/ 10/94 94-252213 TURN ) =1010FK . . : 1 WOODSTOVES. :O B51-)C $ 03 SW 06/06/94 _ FLOOR FURN. . . . :0 CLU DRYERS. . 1 SSDC $ c.'80. 00 SW 06/06/94 — BOIL./CMP ( 3HP:0 OTHER UNITS: 1 PARI, $ 500. 00 SW 06/06/94 GAS OUTLETS: 1 MPRT $ 45. 00 SW 06:+/06/94 - Owner: -- -.---_____—_—_---..___..____..___..__._ __- .._MPLC $ 11. E5 S14 06/06/94 - JAY MILLER M5PC $ 2. 25 SW 06/06/94 - 1' 0 BOX 23291 PPRT $ 135. 00 SW 0.16/06/94 — P5PC $ 7. 75 SW 06/06/94 — TIGARD OR 97281 Phone #: 684-7543 Contractor. ------------------------•—__—_—_— CONTRACTOR.NOT ON FILL I Phonp #: ----------------- 1 ---------•--- ---1 3033. 78 TOTAL This pewit is issued subject to the regulations contained in the -•------ REQUIRED INSPECTIONS ------ Tigard Municipal Cude, State of Ore. Specialty Codes and all other Foot/found Insp Fireplace Insp applicable Ins. All wrrM will be done in accordance with approved Post/Beam Struct Gas Line Insp plans. This pewit will expire if work is not started within 180 Post/Ream Mechan Tnst_tlation Insp r.'ays of issuance, or if work is suspend for core than 88 days. Plm/t.tndslab Insp Gyp Board Insp PLM/Underfloor Rein drain Insp Permittee Signature: � _ Mectianical Insp Wager- Line Irisp Plumb Top Out Appr/Sdwllr Insp 1 'd SV : _..._.....--- -.. Framing Insp Mechanical Final. Call for inspection — 639 -4175 SEWER CONNECTION CITY OF TIGARD PERMIT #PERMIT. . SWR94 0182 COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 06/06/94 13126 SW Nall Blvd.Tigard,Oregon 972234199 (503)539-4171 PARCEL: 2S 1021)U-03000 SITE ADURE 61S. . . : 08361 SW DLEANN (-'I blJBDIV181ON. . . . : FINLEY PARK ZONING: R-7 BLOCK. . . . . . . . . . . LUT'. . . . . . . . . . . . . :(I'14 TENANT NAME. ., . . . : UGA NO. . . . . . . . . . . FI XTURE LIN ITS. . CLASS OF WORK. . . :NEW DWELLING UNITS. . : 1 TYPE OF USE. . . . . :SF NO. OF BUIL.DINGS11 INSTALL TYPE. . . . :BUSWR IMPERV SURFACE. , s i1f,marks . PA'[H 1 Owner: JAY MILLER type .amol.int by date recpt P O BOX ?3291 PRMT $ 2200. 00 SW 06/06/94 INSP $ 35. 00 SW 06/06/94 TIGARD OR 97281 Phone #: 684--7543 Contractor: CONTRACTOR NOT ON FILE Phone #: $ 2235. 00 TOTAI_ Reg #. . . -- ----- REOU I RED INSPECTIONS --- -- - This Applicant agrees to comply with all the rules and regulations Sewer Inspection of the Unified Sewage Agency. Tho permit expires 180 day, from the date issued. The total amount paid will he forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is rot located aI the measurement given, the installer shall prospect 3 feet to all earections from the distance given. If not so located, the install+r shall purchase a "Tao and Side Sewer" Permit and the A ency wi11 instal a lateral. l 'ei,mittee SignatUr•e : +�ilr✓_. i aed I Call for inspection - 639--4175 _ J C I 1 V OF 1 10ARD - RE:CE_IPT Or" PAYMENT REC-F-'i F11' NO. s 94--P". 13/4 CHECK 0010UNT 3P.1.0. '78 Nf1ME s JAY MILLER E LDL AMOUNT a 0. 00 AH)l ESS s E-AYME.NT DWE: f 06/06/94 liLlE3UIV It3ION f 0 Nil-C1ak OF PAYMEW AMOJN f PAI U PUE7E'3OSE OF PAYMErN f W111 N.lN I 1-4111) 1 NLS PERM MSTg4—018 5 440. 9, 0 PL LMB I NO PERM {►i-IN I l:ill. PF- 405. 00 S1. BUILD PFR HN C;MFE:;K FF 11. H`s, SEWLY4 1_!'SA ow Wf R I NSPF U 1 :303. VILA PFdHKb BBC ;,V+N.IAl1 OkM DRAIN SVC 280. 00 !LES I DE::NT I AL TRAFF I L, F F E-.s•i 1410. 00 � t I RANSI T TIF FFES 1 1 V+. 00 -,A.1 UEEANN GT, LOT 14, E'I NL.E-'Y PARK 1101 r4MDI1N 1 PAID - > 5p 114. 7 E:I Residential Building Permit Application ' City of Tigard 13125 SW Hall Blvd. Tigard, OR 972.23 (503) 639-4171 1 / ( Jobsite Address: 6`6 V Subdivision: �-1 -`--'- Lot # � Office Use Onty 4� Pianckinec# Valuation: Owners � � Reissue of mI P4- v 4ir� p � Address: 7 d 2 Map& TL I c , Appnyals Required Phone' Planning___�_ Contractor: _ Engineering Address: _ — Other Phone: ltern,�'; Ptagulred Sukx;rnt�a�U�ra Contractors Lk:ense # ------——-__ _ (attach copy of current Oregon license) Truss btiiai;s Subcontractors: C,ner Plumbutg: � Mechanical: 1� (attach copy of current OR tractor's Lken,.) Arch'.tect/Englnee r: Address: Phone: COMMENTS: Applicant Signature & Phone number Received by: _ Date Received:__ Permit # Account Description Amount Amt. Pd. tial. Due h1 J- •.0/r Bldg. Permit (BUILD) -41_1�.•SU Plumb. Permit (PLUMB) Mech. Permit (MECH) 4/i au State Tax (TAX) 3,2.0 3 � _ 32.03 Bldg: d a . 0 3 _' Plumb: 7,%.i_v Mech: 2, 2 .)J V Plan Check (PLANCK) Bldg: .5o. Plumb: N1 e, h //• 7.j sr,,�/�ytL• o/g2 Sewer Connection (SWUSA) t2e�U U _ _ LyV _ Sewer In4-x ction (SWINSP) P.3rks Dev Charge (PKSOC) Stomi Drainage Chg (SDI.-,DC) �.2yll _ 9-" Residan,ial l IF (TIF R) _LL1U /�'/U Mass 1F ansit TIF (TIF-MT) _ 116 Commer..:iat TIF (TIF-C) Industrial TIF (TIF-i) Iru^titutiorial TIF (TIF-IS) Office TIF (TIF-0) Water Quality (WQUAL) Water Quantity (Wr]UANT) Fire District (FIRE) TOTALS: �G�'• S O ,2 WV, i t ---;g_ I ' O M co U, r- 0 W Q 7c r V) > O I ~ wC14 CO V1 V�-1 2 co F CJ 67 i sKOD w m / (rj F` w O N bt I � I J C,I T Y OF 1'190W) RECUIPT 0V PAYMUNI l,"E I Pl NO. -. 94 CHIS,K Wif.)UNT n 5 fe). Aa JAY MILLFR BLDW,l, C.'Abl-i P).140 PAYMEAT DOLL x 0' 1(A/94 .3U1.41)1 V I V)ION OF PAYMF-All' AMOUNT Pfillo VL)RPOf:')C' OF PAYPII:,Nl* 0110UNT 1)(410 Sw OFTANN (A W 0MC)UNT 0AID 441. 00