10409 SW PICK'S WAY � •ar 'sr
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-- 10409 SW PICKS WAY
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INSP (aION NOTICE
City of Tigard Building D"partwnnt
13125 SM Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business 'hono: 639-417)-
Inspection:_---J ----
Footing Plbg. Underelab Mach. Rough-..n Appr/Sdwlk
Found. Plbq. Top Out Gas Line FINALi
Poet/Beam Stiuct. Sar:. Sewer F.-arcing -Bldg.
Post/Beam Mach. Rain Drain Insulation --Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mach.
3v
Date Raquested: :3 -,v,_;� - / 6r Tim : _- AM PH
Addre-rsf `7� S w • I C-+�-5 Permit #:L?L.Gr-?/'-0/ri0
T({E FOLLOWING CORRECTTONS ARE REQUIRED:
J `
wa do
----�s 7
tnepector: ----- Dato:- - --
APPROVED DTSAPPROVED APPROVED SUBJECT TO '.3OVE
Call For Retinsp.
MECHANICAL
PERMIT
CITY®FT117ARD PERMIT #. . . . . . . : MEC91-0188
CfTY TWARD)
COMMUNFTY DEVELOPMENT DEP41,RTMENT ORIGON DATE ISSUED: 09/25/91
13126 SW HWI Blvd. P.O.Box 23397.Tgwd.OrOgOn 97223(6031839'4175
I I L HOURE,.:)tj. 10409 SW M- rF9_WV_ ZONING:
SUBDIVISION. . . . :
BLOCK. . . . . . . : LOT. . . . . . . . . . . . .
CLAF-iS OF WORK. . :NEW FLOOR FURN. . . . EVAP COOLERS:
TYPE OF USE. . . . :SF UNIT HEi-�TERS. . VENT FANS. . .: :
OCCUPANCY GRP. . :R3 VENTS W10 APP'Ll VENT SYSTEMS:
BOILERS/COMPRESSORS HOODS;. . . . . . . .
�-.')TOPIES. . . . . . .. . . 03 HP. DOMES. INCIN:
FUEEL TYPES---------------- 3-J.5 HP. COMML. INCYN:
BTU 15-30 HP. REPAIR UNITS:
MAX INPUT: 30-50 HP- WOODSTOVES. - : 1
DIRE= DAMPERS?. . : 50+ HP. CLO DHYERS. . :
LAS PRESSURE. . . AIR HANDLING U 1\1 IT S OTHER UNITS. :
NO. OF UNITS-------- --
100K BTU: 10000 cfm: GAS OUTLETS.
1-UPN ) =1.00K STU: 10000 cfm :
Remarks : INSTA!_1IN WOOD STOVE
---------------- FEES ---------------
UlNner: type aMOIAnt by ilaire e C p t
CAMERON Wit-SON PIRMT $ 25. 00 PLL 09/25/91
10409 SW PICKS W1, 5PCT t 1. i,*.'5 PLL. 09/..5/91
TIGARD OR 97224-0000
#: Oti -Ali,
OWNER
___.__$__.-.-`6.
26. 25 'TOTAL
1- flutle #:
Reg #. . '. --- REQUIRED INSPECTIONS
This perLit is issued subject to the regulations contained in the Final Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will he one in accordance with
approved plans. This permit will expire if work is not started
within 18m days of issuance, or if work is suspended for more
thar 180 days.
lr,ste(j By :
Call fo, insppc-
639-4175
CITY OF TIGARD RECEIPT OF PAYMENT RECEIPT NO. .91-?17654
CHECK AMOUNT : 26-25
CASH AMOUNT : 91.00
NAME WILSON, SUSAN & CAMERON
P'A'YMENT DWE : 09/25/41
ADDRESS a 10409 SW PICKS WAY SUSDIYISION 2
TIGARD, OP 97224- SAME
pUppOSE OF C,AYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
----------
T-. BUILD PF-�
MECHAN 91 as
TN�,TALLIW, A WOODSTOVE
iO4AL. AMOUNT PAID 26.25
City of Tigard MECHANICAL PERMIT Planck/Rec. # -
13125 sw Hall Blvd. APPLICATION Permit
PO box 23397
Tigard, OR 97223
(593) 639-4171 _
j �escnption
Table 3A Meclianical 4'ode QTY PRICE AMT
Job '1) 1 1) Permit Fee -0- -0 10.00
Address ZIP
2) Supplemental Permit 3.00
«�» urnace to 100,000 BIU
1) incl. ducts&vents _ 6.00
Furnace 100,000 BTU
Owner 2) incl. ducts&vents 7.'_.0
.�. zip Floor 1-umance
3) incl. vent 6.00
neater,wall seater
4) or floor moulted heater 6.00
Vent not incl in —
Occupant 5) appliance permit 3.00
fr. epair of eating rig.
6) cooling,absorption unit 6.00
Boiler or comp,heat pump,air coo—
7) to 3 HP absorp unit to 100K BTU 6.00
•a «• �� or er or comp,heat pump,air cond.
8) 3.15 HP absorp unit to 500K BTU 11.00
COnttactor ,,, ., Boiler or comp,beat pump,air cond.
9) 1530 HP absorp unit.5-1 mil BTU 15.00
W NibnN�� rAl P— .. Ekider or comp,beat pump,air cond.
- 10) 3U-50 HP absorp unit 1.1.75 mil BTU 2250
re y ac row ge that nave readis application.t t e Boiler or comp, eat pump,air conU7__
information given is cared,that I am the owner or authorized agent 11) >50 HP absorp unit 1 75 rail BTU 31.50
of the owner,that plans submitted are in compliance with State Air handiing unit to
laws,that I am registered with the Construction Contractor's rsoard, 12) 10,000 CFM 4.50
that the number given is cblTeCt (II exempt from State regisLation, Air handling un;i
please wive reason below.) 13) 10,000 CTM+ 7.50
-- on port IN
14) evaporate cooler _ 4.50
Vent fan connected
15) to a single duct 3.00
Ventilation system not
Z�,
%Q 16) included in appliance permit 4.50w gem Hoodserv_ y
17) mechanical exhaust 4.50
scn w nw— a mon alteration 70—pal-17-
to
epair to be done resriential 0 non residential 0 18) type incinerator 30.00
Fxisting usem— other re,woodstov water 41
'7uilding or property J^L 19) heater,solar,clothes dryers,etc. 4.50
Proposed use of 20) Gas piping one to four outlets 2.00
building or property— rnlr✓
21) More than 4 per outlet
Type of fuel -oil 0 natural gas 0 LPG 0 electric 0 – –
OTICC -
Minimum roe$2�00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR 5%SURC!1ARGE
IF CONSTRUCTION OR WORK IS SUSPENDED OR
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY "IME PLAN REVIEW 25%OF SUB',OTAL
AFTER WORK IS COMMFNCED
TOTAL
Special Coridtions --- --__—,----^ – — ---
__ Date issued by
�.vF<�twr
F .tiyyt 1 �� h ta)br frt' �* My+4 A �k111 ti���q � b
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INSPECTION NOTICE
City of Tigard Building Department I
P.O. Box 23397
T,yard, Oregon 97223
Phone: 639-41177)5
Type of Inspection 4LLi► ---
Dote Requestted,,_// C� �;= ! ya�� Time A.M. P.M.
Address �(-�y�/ / C.��/� J Ll Pbrmit
Owner Lot Lot #
Builder L d 1�� ���Ll—.Y21,a(a --The following following Building Code defieieo%-al are required to be corrected:
�E-�!r' ,�F��C f d L3 F' i�S�"�//.!�'��._...J' d r.✓NC�f', _ _
=,r a / _ - -
c 3,5
Presented toppreved
Inspector _ U Disapproved
Date
CALL FOR REINSPECTION
0 YES 0 NO
INSPECTION NOTIf
City of Tigard Building Depa+l tment
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested ` Tim4tY44 A.M. P.M. ? /
Address1:)Y 1��rCs.c�-R — Permit
Owner Lot
'The following Building Code deficiencies are required to be corrected:
C _
pre- n.S _ I Approved
Inspector y Disapproved
Date --
CALL FOR REINSPECTION
❑ YES L] NO
131,11LUING KA-4MYT
C'7YOFTIFARD �IV
PEPMT-T NO. : St.1881631
DAI E; ISSUEU: (3/31 8/8
COMMUNITY DEVELOPMENT DEPARTMENT OMOOM P14I.M . GSM T.W. e(316'1*51.
13125 S.W.Hall Blvd..P.O.Box 23397.Tigard.Oregon 97223.(503)639-4175
AIGIWHkiiSiiii . +09409 SW PIEKS WA'f
10X MAP/I 01' PSI 14B0 SUB: SWANSONS1 W-EN
LAND USE : P 1.
L O'l SIZE: VAI.11A'TION; 111 57 ,Pe7 SETBACKS
F'PON'T : 20
WORK CLASS : NEW UWEI L. !JNITS 1. LEV T . 9 n I E.ATT It?7
SINGI-E FAMILY NO. BEDROOMS : x V'X I' WAL.I GONST :
(")NS-' T* . TYPE" ; VN NO. RA'1+4!5 : I's N G E:, : W
OCCUP . OPP. 1:13 14401' .OPENINGS :
OC CUP I OAD N S E. W
TOTAL AREA: 1.P 3(3
NO . STORIES : 2 1 S'T : 652 ROOF' (:'DNS*T : C F.-TRIF. AC-l"?
HE MIRY' : PO PND: 5IR6 AREA SEPAP7 PAITKI)
CJASEMENT? 3PD: OCCUP. SE PAR'!
Ml'::ZZANI:NF.'? BASI:::M"T
F I OUP LOAD : (to GA PAGE: 400 I::JPE SPPIKI-1:17 AL.AAMI?
V LAW 11,.Ipm) DE TE YE'S
1-1 DC,P S 7 COPR7
AIH.MAPK!:j :
REISSUE (IF' NO. 6635
LAST RF--*:tS5L11F.* H9i.640
81.,EAK MORGAN F E WM I'l, 1111307 00
F1 1:1 DOX 6835 PLAN REVIE W $40 . 0(1
W ilk 3.(3 h itt (3 r, FJPE DEPT'
N
F S IWVE 'TAX $1 15
R 01 Hr R
DEVE-i:111-OPHL'N't CHAPG1--':15 :
R 04 K SoC,4 S 1,01:41411) 41250 ,00
-111AN PP(.)PF:o4*1T+.5 INC . SDI:,( S'T*141--F:I'll
0 11111600 .00
N Pill IROX 6835 PIR,1#2 11 1112'n.)0 . 00
f
R ALOHA UP 97007 683.5 P A E-':P A.T.U < S-10 . 00)
A 1:1-40NIF. (503) 6(34•••6606
C
T REG I.00RATION NO 30550
0
/k I
RECF*..i:P,r No . A
T his permit is issued subject to the regulations contained In Title 14 1'4EQLJIPFA) INSPECTIONS
of the TIVIC. State of Oregon Specialty Codes, zoning regulations F 0(:1'1 I N G CJE:WEP
and all other applicable codes and ordinances, and it is hereby VIIIIJINDO-1 ION WAL.L. RAJ`N DPATNS
agreed that the work will be done in accordance with the plans and POS'l & "EiAm WA TE LINE
specifications and in compliance with all applicable codes and
ordinances The issuance of this permit does not waive restrictive 1:1-191 UNDEPSLA" ca rY APPRU.1-4/5W
covenants Contractor and subcontractors shall have Current city S L.A F1 F- INAL
business tax permits This permit will expire and become null and PL R . I UPOUT,
void If work is not started within 180 days,or It work is suspended or I:'PAM TN(*.,
abandoned for a period of 180 days any time after work has
commenced. It shall be the responsibli..:^f the permittee to assure F'TPE.P1 ACE
all required Inspections ate requested and approved toA S I_.I N E.
INSUL.A1111IN
(.,;yP . BOARD
4Permittee Signatmo
CALL FOR INSPEC-TION 639--4175
Issued By' —J
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
PLUMBING PL:*14M:l I
PEFIMIT NO. : P11-081 6 56
CITY OFT167ARD VATE ISSUED : 8/31 /E03
CITY OF I WARD
COMMUNITY DEVELOPMENT DEPARTMENT PRIM , PMT.NO . 00163 1
13125 S.W.Hall Blvd.,P.O.Box 23397,Tigard.Oregon 97223.(503)639AI75
Y"'X MAP/L.01, 2S i. 141181H !:)I.Jki: SWANSUNS GLEN LJ : *15 UK :
USE : PJ-VPD
('11 SIZE :
ITEM! NO i
WOWK CI ASS - NI:W WOTEP GLOSE T' 3 THAP
USE 'T'YPI::.: 5:[N(*.,I...[-.: 1::'AMTI..Y UPINAL. 81<Fl-()W 1:)I:,,VN'T'R
CONST .TYPE : VN I AVORl-'ITORY A 'TPAP
W'I
CUP.G.PP. : n3 TUB SHOW.K14 2 'T'RAPS
DISHWASHEP I.
(.*,AP8A(;P'. 01SPOSAL 1.
NU. STOPTES : 2 WASHING MAU-41NE 1.
DWI.L. . UNITS I L.AUNOPY TRAY BLDG. DRAIN (DIA
rLOOR DRAIN
SINK I ':&-.WF:A (F:T)
WATER HEATER 1. STEMM/PAIN (1-. 1 1.
011-11FM
PEMA11:4103
L:11.1 A- K MUPGAN P F-44 M I T *132-150
W +n]r�F1� Ill FIXTUPES
s,rA*l s.: 'T*AX tN F", 6'13
0 REN WA*1'1'!-) PLUME)ING
N BOX 23091:3-5
T
R ti il;j a i--(:I c1 r• 97223
A Pli-IONE (50'3) 6841--64126
C
T PEGISIF110"TION NO . "50070 r(.)'T'Al *t39. 1.3
0
F1 REGIL I P'T NO . oo 5
This permit is Issued subject to the regulations contained in Title 14 PEW T REM I NS PECI I ONS
of the TMC. State of Oregon Specialty Codes,zoning regulations PLU UNDEASI-AD
and all other applicable codes and ordinances, and it is hereby PUST a REAM
agreed that the work will be done In accordance with the plans and WATEP LINE.
specifications and in compliance with all Rpplicab(i codes and
ordinances The issuance of this permit does not waive restrictive 11.•.8. TOPOUT
covenants Contractor and subcontractors shall have current city PAIN DPAINS
business tax permits This permit will expire anu become null and F-INAL.
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 required inspections are requested and approved
Permittee Signature
Issued By. ('611 rnP 1141";PFC17117111119 6.49-•q1%9
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
ttltts
MECHANICAL PERM.0
CITY OF T'GA RD �r,
PEWMI T' NO. : MEE11311.657
RD DATE 'I.SSUCD: 8/31/88CdYMND
COMMUNITY DEVELOPMENT DEPARTMENT Ono" Prim. i..1mT.No. 881631
13125 S.W.Hall Blvd-P.O.Box 23397.Tigaru.Oregon 97223.1503`6351-4175
_
TAX MAP/LOT 1,010B SUH : SWANSONS C-ILEN LT :45 Bl<
LAND USE: 111.�.*i P 1)
LOT SIZE: :
:I TEM NO: NO:
WORK CLASS : NF.W FL)PNACAE: <100K 1. AIR HANDLP <10
USE TYPE: : F'AMJ:I-.Y F'UPNACE 100K4- AIP FIANDI.-P 10K
CONFiT. TYPE VN FLOOR FORNOCE FUAP. COOLE-14
OCCUP . GIPP . 143 1-11EATER Vl:;.N*T* FAN 3
V E:N T kJENT , 5Y�;TEM
Bi-n/comr, csi-ir) HL)OD 1.
NO . S1 0 P I V 5 1?2 8L.A/ClOMP 3-151-ip INCINEPATOP f DOM
11WE'L.L .UNITS : 1. 61._R/C0MP 15-301••P I Nt*.'l NE PAT 0 A(C C)M
rlIEL TYIDL C,A 5) BL.N/GOMP, 30-50HP PEPAIP UNITS
MAX . INPUT 81-PI/ClUM1', 1150II-1-R)
F-IRE DMPRG ? (*-,AS PIPINC; OUTLETS 1.
HT GH
1 Ow
PE—MAPKFi :
L
B L LE A K MORGON PERM]''T $1.0 .00
0 134:1 EX)X 41`1931`1 V'l AN I:*.'V1L-`W 101.1.0 . 13
W K1011L or FIXTURES $130 -50
N
E STATE-" TAX $P, 013
R OTHEP
C
0 FJL-"1. L HKATING INC.
N PIAZZA AVI'-*
T
R GLC ,5
AKAMAS tip 970t
A PHONE (503) 243 -1.1.FM
C
T PI-EGISTPAT -I'll-I)IN NO . 447 TOTAL : 1114a, 65
0
R Ile
I;IE(*,I'---]:P*T* NO 5
This permit is issued Subject to the regulations contained In Title 14 PE.QUIRE-D INSPECTTONS
of the TMC. State of Oregon Specialty Codes, zoning regulations C;A S 1. 1.N L*
and all other applicable codes and ordinances. and It Is hereby r1015 T P& BEFOM
agreed that the work will be done in accordance with the plans and PIC)LICsH IN
specifications and in compliance with all applicable codes and
ordinances. The issuance of this permit does not waive restrictive U INA1.
covenants Contractor and subcontractors shall have current city
business tax permits This permit will expire and become null and
void if work is not started with n 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 re!;pnnsibility of the permittee to assure
all required ingpections are requ!.sted and approved.
permittee Signature �
1'A1...1. FOP :Il-!SPEC TION 639 A< 15
Issued By SEPARATE PERMITS REQUIRED FOR WORK OTHER THA14 DESCRIBED ABOVE
SEWI`44 PEPM11,
CITYOF TI&ARD
NO.
C YOF �AID
COMMUNITY DEVELOPMENT DEPARTMENT oploo
DATE ISSUED: H/:31./88
13125 S.W.Hall Blvd..P.O.Box 23397,Tigard,Oregon 9720,(503)6394175 PPIM . PMT .NU RB 16:31
J08 AD014ESS : 1.0409 SW PMKS WAY USA NIJMF.iE:I.'t : 036A11
1 A MAP/L.01' 2SI. 11DH ISUD: FsWANSONS GLEN L.T : /1,5 1:3K
LAND USE: : 1.41 R PE)
LOT !-,)]:Zr-- :
SECTION : 144 TWIP: 2ta PNG: I w
WUPK CLAInS : NF--".W
U!"5E TYPE. - SINCLE* FAMII-Y
TI-le awr.)1I(:4lI.IIt it1g11"leels to colliply wit'l-I KIJ I-'tlT1F'l%I ilincl I Att.i an% o4l tAieUnified
!-Jf..VW1.67.1I`akge I'ligil," 'The per,mit expir-tom t20 di%yis -Fr-ciin ,lice datc, J.miamecl . T h e to t'at
01.M c)ki I 1 1. 11:)ak i(J W J 11 la e 41 r.)I"-F(,-,?1. 1.e d :11,-17 1.1 le 1:)Cut I,l":1 L 0)X pi I•ral li, 11-h a A f;I C I-I ck)e w I 1(.1 t 9 1.4 at I"-
fft.ntev the (:).(! Lhe bac,attic)ll n4f td-la-) talicle taK wear liatel,aata . 1 d thfra tae.wlmr- 1!1;
sit, tllgp Incamill 1.11,ve tile I's t givkarl ' thea iniatia:I 'ler, t6llial.1-:11. pir,uthpiatc.,t 3 in
atEll. clir-vc.�Lian% fi,onv they. clisttvinve given . 1-117 not via loc.,ated , the inatittiler, !fl-iiii.I.J
P1.1 r Chili tra is "Tat I:) M11 cI Si.(1 to Sewer," Poi-ini I. atrici t h Ili? Aq a r I c-,k) wi.1:1 :1.1 "i :1, K Int I,el I,ilk
IN15VAL.L . TYPE : FJUJA DINC, SEWEP IMPE"RVIOUS AWE.".A:
rxxrum UNT'US : '11.i.NAN'T' IMPROVEMEN'T
OWE'LLING UNITS : t
NO. 0F 81I.-MCS . I
14011:411,,AN PCERM11, 4135 . 00
W PC BOX 601311) C0NNEc'r10N CHAT UL. *1 1.00 . 0()
N
E lit] 1:1111"Illk Ull L TNE 'TAG` INSIAL.L. .
41-FAK M 1)IF 4 GA N
0
N 'T':I: TAN VIPUPEPIJES INC .
T
R PO BOX 681515
A AL M IA OP 9,7007 68,305
C
P
T HUINE.: (503 6
) 6H,01-.606
0 PEGIS141ATI(IN NO 3 0 55 8 'TOTAL : $1 ' 1'35 . 00
R
W�-:M'.I P'T NO
This permit is issued subject to the regulations contained in Title 14
of the TMC. State of Oregon Specialty Codes,zoning regulations PIEW1144A) INS;-*.:r.-1J(:)NS"
and all other applicable codes and ordinan,,P-;, and it Is hereby V4(:11L)GI-11--I IN
agreed that the work will be done in accordance with the plans and
specifications and in compliance with all applicable codes and
c,dinances The issuance of this permit does not waive restrictive
covenants. Contractor and subcontractors shall have current city
business tax permits. This permit will expire and become null and
void It work is not started within 180 days,or it 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 required inspections Are requested and approved.
Permittee Signature
Issued By: (';A[ L F IM INSPECI'ln
':�EPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCNIBED ABOVE
CITY 'UCS.
OF TIGA D PIAN CHECK APPLICATION
CITY Of TIGARD PLAN CHECK N 4 _
COMMUNITY DEVELOPMENT• DEPARTMENT OREGON ���- PERMIT N -
13125 SW FWI Blvd. P.O.Box 23997,Tigard,0,,g i 97223(503)G994175 --
DATE ISSUED
;TOB ADDRESS: 12 -��,¢�i TAX MAP/LUT
SUB:
VALUATION: LOT:- ' yS LAND USE:
_ T —
OWNER SPECIAL NOTES
NAME: L � _ _ REISSUE OF: _
ADDRESS: �p _ -4 - LAST REISSUE:
FLOOD PLAIN/
SENSITIVE LAND:
PHONE: .--�
CONTRACTOR
-� APPROVALS RE UQ IRED
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:
COMM!-N FS:
PERMIT # ACCT H DESCRIPTION AMOUNT AMOUNT PD. DAL. DUE
SY/4. 2/ 10-432 00 Building Permit Fees v or, - -3107,C,v
�Y_4- 10-431 00 Plumbing Permit Fees f�3Z• �z - 13L �Z
c*.V 10-431 01 Mechanical Permit Fees -10-230 01
State Building
Tax (5%)
Building "-
Plumbing
Mech n& 3
10--431 00 Plans Check Fee .Sn.l3 ciU .UG 10,13
Dui Idiny c> -
Plumbirrl _
Mech __—i/(� _--
30 -202 00 Sewer Connection /vu _//Gu
30--444 00 Sewer Inspection 3 j --
51--448 00 Street System Dev Charge (SDC) 400
�'—
GJO
52--449 01 Parks I Systen Dev Charge (PDC) -'
52--449 02 Parks II System Dev Charge (PDC) Z235 2SD
31--450 00 Storm Drainage Syst Dev Chrg (SSDC) v2 .5U
10-•-230 09 TRFD - —
10-230 06 Washington Co,inty Fire 111 -"
10--220 00 Amar•t/Wedgewood ---
TOTAL
APPLTCANI S]GNATURE -- �-
Roce.vend [1y : ___-�-_ — -^ Date Receivel:
ht/3587P/18P --_