14662 SW 83RD COURT 6
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01YOF TI , ARD
COMMUNITY DEVELOPMENT DEPARTMENT CERTIFICATE OF
1'A25 SW Hall Blvd.Tigard,Capon 97223.8199 (503)839.4171 OCCUPANCY
xxxX PERMIT #. ., . . . . . Mc.3,T93
639-41771 DATE ISSUEDP 08/02/93
PARCEL: 251128C-12100
SITE ADDRESS. . . s 14662 GW 63RD CT
SUBDIVISION. . . . a STARLING CROSSING ZONING:
BLOCK. . . . . . . . . . a L.OT. . . . . . . . . . . . t 00%.'.
CLAS; OF WORK. aNC'W
TYPE: OF USE. . . a fir.
OCCUPANCY GRP. r R3
OCCUPANCY LOADa222 4
TENANT NAM[-.. . . :
Remar• (% c E,A-m D TIF credit LRD93• X+001
D E ANDERSON INC
5C`5 FW 96TH AVE.
BE'AVERTON OR 97005
Phonp #: b27-1999
Contractors
U LANDER SON, INC
4575 SW TUCKER AVE
BEAVERTON UA 97005
'hone doe 627-9999
Reg #. . -. 46344
Occupancy of the abose referenced building is hereby given, and rertif.ies
the compliance with the State Of Oregon specialty Codeq for the gr»oLII3,
oczupalncy, and use under which the re!Ferenreci permit was issued.
F IRE DEP'AP TME�f__ DItN48—.P—EeCRL
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POST IN CONSP I CUOU3 PLnCF_
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PLUMOING
CITY OF T IGARD r"'E r�t � , . . {
COMMUNITY DEVELOPMENT DEPARTMENT I)AIL ISSU-i D.
13125 SW Hall Blvd.Tigard,Oregon 9722308199 (603)e39-4171
ZUN,NG
ION. . . .
Of WURK. BACKF LOW PRE VNI rim. .YF Ic' OF UGLL. . WASH�.NG MACH. . . . . . . : 1
J"L15. _ . . . . .JZJ -P(�Ps. . . . . . . . . . . .
LUOR DRA
R HEATERS. . . . . . : 1 CAT.""H BASINS. . . . . . . .
. . . . . . WATL
lx'[' Jr --- LOUNDRY TRAYS. . . . . 0 0
-,1S. . .NK . . . III I. - . ' I — 0 .
0 tj A T 0 FR I RU
01; i;1---R 171XFUJ. . . . . .
UB/SHOWE R'8. (U-WER LINE
Tc:.R L 1 1�L" (rt
;1SHWAHL RS. . . . Rf-)IN DRAIN (f t) - -
qct
TIF $ j460- 00 j!I
ANUV-RGLJN Nu BPI RT $ 352. 00 Ji-i 04/20P)IL
SW S6TH OVE s w2 L'VI. 6 0 JLH 0 3 0
BtIpc 1'7.G 0 J11 ld74'4
" 00 JH 0 4 c.21/9
D C; L.,80.
PARK t1i 0 i�. j H L
-43. 50 JII-4 W14,
mPL-c $ I k?j* ba jfl
m5rc 4, 2. 16 .,H
P ,R T' $ 132. 50 JH 04/� O/9",
5 L t e 6. 63 Jil 04/20/"7
Uri e#-
RLUUIRLD INear'LurIONS
,uj; to the i eg i d
cat-jLa�nvd ir thv ligard MILMiLipal Fovktifound 1;:Sp
Cu(jeti alld LAII 1- t Dei;i�k m 5 t k.1 u-t wal�cr I-Ine 11�sp
err 1rtrs
be �j p-)pv,/8dw1k
j1pplicaLle i&iws— ►P11 wuw"< will . ore Post 'Beam MeCtI&I-1
with appcoveci plawi. lhit� lnsj�')
started PIL.M/Urider,f iuor r-'1'1 .tl m b F i nek i
t p wu (it id
-Atlu"Iw (I V, if' w 0
1616 d�A� ,L �) f
f.jr, mut e tj-sao 160 days. ►"Iumb iop Erosion L,'-ontrc ,
Framilig 11)" V wr
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irl'41.41ktian Ingp
A C y p .,Trsp
cz
INSPECTION NOTICE
City of Tigard Building Department
13125 SN Ball 81-yd. Tigard, Oregon 97133
Inspection Line (Ree-O-Phcne): 639-4175 Business Phone: 639-•4171
Inspection:_
Footing Ilby. Underslab Hoch. Rough-in Appr/Sdwlk
Found. P'.bg. Top Out Gas Line FINALS
Poet/Beam E.truct. San. Sewer Framing -Bldg.
Poet/Beam Hoch. }fain Drain Insulation -Plumb,
Plbg. Underfloor Water Line Gyp. ad. -Neck.
Date Requested: �� TLWAI _�(- AN PN
Address: f� `_2*3- L_ Permit fs —oLz,
'-Y J
Builders
THE FOLLOWING CORRECTIONS ARE REQUIRED:
I ;.;STA% L- �._ �q1A)j,�Ayr=S Tn
Al
f-PA c6L T'o
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Inspectors L /
APPROVlD DISAPPROVED ` /APPROVED SUBJRCT TO ASOVZ
Call For Reinap.
INSPECTION NOTICF /
City of Tigard Brildinq Departasent /
13125 SW Ball Bled. Tigard, Oregon 972 f"
Inspection Iine (Roc-O--Phone): 639-4175 Business Pho 639-4171
Inspection:____
___
Footing Plbg. Underslab Hoch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALt
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation
Plbg. Underfloor Water
�7Line Gyp. Ed. L -Neoh.
Date Requestteedt � /
/
l J._3 / Ctme: J1M PK
Addreses Permit # —.4"ll,
Builders
THE 10LLOWING COORRRECTIO(N^S ARE REQUIRED:
r l�cY)2
Z= A25
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Inspectors Date. `
r �
APPROV=D DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
INSPECTION NOTICE_
City of Tigard Building Departs
13125 ON rlall Blvd. Tigard, Oregon 97
Inspection Line (Rec-O-Phone): 639 4175 Business Phone: 639- 171
Inspection:_ - ---
Footing Plbg. Underslab Hach. Fough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAF.:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation (� Plumb•
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Date Requestedi •"�f `� /�/A OeTime: - AM PM
Addres,It-r ��' �� r/� J�1r__ Permit J:
Au. ;Orr ae,4 "10
TRE lOI.LCMING CORRECTIONS ARE RRQIIIRF.D:
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"PROVRD p:SAPPROVED __ APPROVED SU CT TO A
Call For Reinep.
NI SPF.CTIOH NOTICE QTC
'r city of Tigard Building Department .-
13125 SW Ball- Blvd. Tigard, Oregon 97223
In-;ectinn Lire (Rec-O-Phonne)i 639-41?5 Bue'.ness Phone: 639-4171
Inyi,ectio,s —
Footing Plbg. Underalab Mach. Rough-in Appr/Sdwlk
Round. Plbg. Top Out Gas Line �lIBALe�
Post/Beam Struct. San. Sewer Framing -Hldy.
Pomt/Beam Mezh. Rain Drain Insulation -Plumb.
Plbg. Underfloor water Line Gyp. Bd.
Date Reiquesteds _ �7l � TLMI AM !M
Address: L IoLl L'_ ftroLt b mqm 3_0 ?
Builder: N'VAk71A
TBE FOLLOWING OORRECPIONS ARE REQUIREDI
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Inspactor /,-- _ -- -- Date
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
INSPECTTON NOTICE
City of Tigard Building Department
13125 SR Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rac-O-Phone)s 639-4175 Business Phone: 635-4171
Inspection:��—�
Frating Plbg. Underelab eoh. Rough-in Appr/Sdwlk
Found. Plbg. Top Out to L1ne FINAL:
Post/Beam Struct, San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor water Line Gyp. Bd. -Hoch.
Date Requested
: 1 % Time= / AM PN
Address: 7 Cry( L �3 r C, ! Permit t C'� -10
Builders
THE FOLLOWING CORRECTIONS ARE RRQ'IIRED:
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Inspector: _ Date:
APPROVED DISAPPROVsb APPROVED SUBJECT Tn ABOVE
__Call For Reinsp.
---------------
1
INSPECTION NOTICE "
City of Ti.garZ ttuilding Departa�nt
13125 811 Ball Blvd. Tigard, Oregon 9
Inspection Line (Roc-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Underalab Mach. Rough-in Appr/Sdwlk
Pound. Plbq. T!p
�_- OYt Gar Lino FINAL:
.
Post/Beam Strutt. Ban. Rower Framing -Bldg.
P.C-t/Beam Mech. Rain Drain Insulation -Plumb.
Pibq. Undortloor slater Line Gyp.
Gyp. Bd. -Meeh.
Date Requaeted: �� �� / Timee ��'t SAM PK
2_ � - �Z1.-�- alG3
Addraser Permit �t
Builder:
THIS FOLLOWING CORRECTIONS ARE REQUIRED:
fti
LDN
J
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-7
Inspttcvo
bate:
APPIIO'VtD bIBAPPROVlD APPROVED eUBJECT TO ABO'/E
Call For Reinsp.
INSPECrTON NOTICE f
Cit.Y -Z Tigazal Bui Ling Delwrtaent
13125 Be Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)t 639-4175 Business Phone-/639-4171
Inspection:_
Footing Plbg. Underslab J Appr/Sdwlk
Found. Plbg. Top Out Q O-aa Line FINAL:
e
Post/Beam Struct. San. Sewer Framing -Bldg.
Pest/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Hoch.
7 '
Date Requastedf `� � Times ..AM PH
AddresstZ Yd
Sr=i C� _ Permit
Buildor:
THE FOLLOWING LMRRECTIONS ARE REQUIREDr
Inap+otore Dates
` vz
\� APPROVEb DI/AFPIIDVfD `_ AiPDOVDb DOD.iDC.T !O ASOVS
*�--- Call For Rainsp.
INSPHCTION NOTICE
City of Tigard Building Department
13125 till gall Blvd. Tigan 1, Oregon 97223
Inspection Line (Rec-O-Phone): 639-41^d Business Phone: h 7t1
Inspection:, _
tooting Plbg. Underslab l h-ink Appr/Sdwlk
Fund. Plbq. Top Out (las Line FINAL:
et/Beam Struct. San. Sewer Framing -Bldg.
Poet Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. underfloor / Nat-Dr Lie GYP. Bd. -Hach.
Date Requested= �/ ��� Times AM PH
Address LL� � r ` �j Permit it!
Builder: 2 27
�-
THE FOLLOWING CORRECTIONS ARE REQUIRED:
1
Ln�platOC
too
DISAPPROVRD APPROVED SU CT TO ABOVE
Call For Relnep.
NSPECTION NOTICE J9_4171'city of Tigard Building Departaent13125 Sit Ball Blvd. Tigard, Oregon 972$
Inspection Lioa (Rec-O-Phones 63Q-4175 Bunineea 1, 0.
Inspections__
Footing Plbg. Underalab Mach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALS
Past/Beam Struct. San. Sewer 1 Framing -Bldg.
Post/Beam Mach. �jjn Drai Insulation -Plumb.
1 bg. Underfloor &tar Lines Gyp. Bd. -Mach.
Date Requested s 1/7 ,,2 . 1 Uasi Plf
1.
Address Permit Ii
L1
Bu l ldar s
TAE FOLLOWING cORRZCTTONS .:P.K R"VIRSDt
Inspectors _ Data.
APPROVSD DTSAPPROVED APPROVED SUMTECP TO ABOVE
Sall For Reinsp.
SNSPECP.ION YpTICE
City of Tigard Uuiiding Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-o-Phone): 639-4175 Business Phone: 639-4171
Inspection:__
Footing Plbg. Understnb Mach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/seam str4Ct. San. Sewer Framing -Bldg.
Post/Beam Meoh. Rain Drain Insulation -Plumb.
vnderlloo!) Nater Line Gyp. Rd. -Mach.
Date Requostedt `�- _Time: ) AM "PM
Address: /y(O.S� Permit It
Builders_
THE FOLLOWING CORRECTIONS ARE REQUIREDs
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W
Inspector:
Y APPROVBD DISAPPROVED APPROVED SUBJECT -j ABOVE
Call Por Rsinrp.
v INSPECTION NOTICE ;^
City of Tigard Building Department
/ Y 13125 SW Ball Blvd. Tigard, Oregon 97223
39-4171
Inspection Line (Rec-O--Phone)t 639-4175 Buoineee Phone.
Inspection:_ —
C
ing /
Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found.
Plbg. Top Our Gas Line FINAL:
Poet/Beam Struct. San. Sewer
Framing -Bldg.
Poet/Beam Mech. Rain Drai:t
Insulation -Plumb.
plbg. Underfloor ��/ Water Liae Gyp. Bd.
Mech.
_Time: AM PM
nate Requestedt_/ / / / /
Addreeet
/ �(L"S. Z Permit -ZZ G� J
nuildert
THE FOLLOWING CORRECTIONS ARE REQUIRED:
ft'
F--
tn
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J
Cal
L7
V.:
J
n Rtes
Inspect — --
APPROVED DISAPPROVED APPROVED BUBJRCT TO ABOVE
Call For Reinsp.
INSP, zT�o_N�7oxrce ��
City of Tigard Building Department
13125 SN Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-o-Phone)t 639-4175 Business Phone: 639-4171
Inspections —— —
Footing Plbg. Dnderelab Mech. Rough-in Appr/sdwlk
Found. Plbg. Top Out Gas Line FIMALt
Post dr, . Struct. San. Sewer Framing -Bldg.
Post/Blom Mech. Rain Drain Insulation -Plumb.
Plbg. Dnderfluor Nater Line Gyp. Bd. I -Mach.
Date Reyuestede c��/ -� Timet / AM f PN
Addreass /`�l�L��2— cy /y PemaLt t
Builder:
THE FOLLONIMG CORRECTIONS ARE REQVIRSD:
CL
y
J
CM
C9
111
J
Inepectors1
\ APPROVED DISAPPROVRD APPROVED SURJECT TO ARCM
Call For Reiusp.
INSPECTION NOTICE
Cl Cy of Tigard Building Department rf+
13115 BR Ball Blvd. Tigard, Oregon 97223
inspection Ll�.e (Roc-O-Phone): 639-4175 Business Phone: 639-4171
Inspections
Footing Plbg. Underelatb Hoch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALS
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor //. Nater Line OY1. ed. -Hoch.
Date Requesteds / fG' -/c�f ��� Time AH PN
Address:_,/L/[�(�� ��� y CI permit
Builders
TNS FOLLOWING OORRECTIONS ARE REQUI!'.dDs
D_
CY _�
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�eQLOYI
\ _APPROVED DISAPPROVED � APPROVRD RUBJECT TO ABOVE
Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 ON Ball Blvd. Tigard, Oregon 97223 w. ~
Inspection Line (Rec--0-Phone): 639-4175 Business Phones 639-4171
Inspections_
Footing Plbg. Underslab Mach. Rough-in Appy/Sdwlk
Found. Plbg. Top Ou' Gas Line FIVALs
Post/Beam Struct. Sart. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Lrain `l Insulation' -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Mach.
Date Requestedss . / f Times //� AM PM
Address: _/�71C)�J(! Z �- `� I ��a Permit 1st%J efI4 _
Builders
THE FOLLOWING CORRECTIONS ARE MMIRM
-70/,5 7-5
S,r�A/. c�c 71 Ly
Inspector:+ ~— Dates /
__APPROVED L/ DIRAPPR D APPROVED SDBJECT TO ABOVE
Call For Relnap.
CITY OF TIGARD --- RECrIPT OF PAYMFNT Rr-c-,L;-I P,r NO. a93-G'39161
AMOUNT 3469. 7,*'�.
NAI,,lF- c ANDFRGON, D. F. CASH AMOUNT 0. ovi
ADDRESS PAYMENT DATE 0 4 0/y3
131JBD I V I G I ON
PURPOSE OF PAYMENT iimnlJNI' PAID PURPOSE OF AMOUNT PAID
rr
3,32. 00 PI-LIMBING PERM 1,32. 50
MECHANICAI. (:'r-- 43. 50 f`"r. BUTLD PF*R P6. 41
PLAN CHECK FF. 0. 3P SEWER 06A El I00. +h0
cn 13E.W I'R INSV,r.,.(-T 35. 00 PARKS SPC 500. 00
rtlFtih DRAIN IN P-80. 00
Lo
i,-or' i. srs;RLING CPOSSING
14666 SW 83RD G'I
TOTW.- AMOUNT PAID 34613. 73,
CITY OF TIGARD
MFasTR PERMIT "
COMN*JNITYDEVELOPMENT DEPARTMENT PERMIT '#. . . . . . . . 11ST93
.rd,Oregon 97223.1110 (&33)131.4171
P3126 SW Nut Bbd.Tigard,
t rDATE ISSUED: 04/20/93
a cy w,d_ •; ,
I �_.: (;L)13RL:3G. . » 14C-j(sw taw 63RD L I Pi.'ARC;EL
t.i' �lIVISiQI�I. , . . : S�ARL'ING CROSSINU ZONING»
t_+. IC, .. . . • . ,'� . . : LUf• . : . . . . . . . . . . :+ 0
BUILDING
'1t- T 3cai�C
DWELLING UN 1 TS: 1. RAGE NENI.. . . . . . . . .0 sf
:i.? ._ ._._._....,_._ ..._, sf
•
REG{11R; DSE'TBHCK ._ _ _ ._ _.lF U34. . . :S" FLUOR ARiAJ
OF" f3NST. :5N F I RST. • . . o740 sf LEFT. . %5 ft R I.GH1 . .5 f'L
GNP. ,f :660 sf F"RONT. :4:4A ft REAR. , : IS `ft
:�7'0RIF-76, . . . . . . .C` THIRD. a0 sf RE:QUIRE.r?__.... .._._.._.:._ _.._,._..__ ..._..
Hh 16141'. . . . . , . . :'Li,2' f t T 0;_RL _» 1400 sf SM^KC UCTEC'Tont� . :Y
1-1-OUR I_UAD. . . . ..40 p s f VALUE:• . . . . $ 72428 PARK ING SPACES. . s 1 .
'ism rk+ F+111i 8 TIF"" credit CRU9B- 0001
_ _...._. .._ .....,_..:__..._. .._._._ �.._.....__._.___-- PLUMBING
Ir l."G:. . . . . . . . . . r 1 pLUOR 1tJRAING. . . . :0 BACKFLOW PREVN FIkS'. . :0
l=1VATUr?1LS. . . . . .* 3 WATER HE:A`mRs. . . - I TRAPS. . . . . . . .
ULIlviI;}tv[1lj,3. . ., . LAUNDRY TRAYS., . :0 CNfoi BASINS. . . . . .
40 f L_UGE S. . : GEWER LINE (f t ) . :0 GREASE TRAPS. . .
'�JHWASHL RG. . . . : i WATC`k LANE (ft ) . : 100 OTHE.II r.tXTUrF:S. . . . . ..0
,�7HRBAOE L) sp. . . . 1 RPIN DRAIN (ft ) . :0
WF-19H I NQ MAC14 . . : 1 GF RAI N DRA 11\18. . : 1
U141 T1ITR 7. . :0 typL= amount by date recpl:
VENTS . . . . . »0 TIF $ 0. 00 JH 04/20/933
+1WA INPUTOZ.: STU VENT FANG. . e +'i UPRT s 352. 00 J14 04/E'0/9 3
URN t LOOK . . : 1 HUUDS. . . . . . : 1 BPLC: t 228. 80 ,JLhi 03/09/ )3 193-237594
z O WUlJD1,T"TDYES. :4'_+ E15F='C 3 11. 60 J'1 04/20193
l...f)0R F'URN. . . . m0 LLD DRYERS. e 1 SaUC `Q0. 00 JiI + 4/ 0/9,3 7
!lTL/Cf la t ;,Iir✓:kh b'T[iL(4 UN11'S: 1 PAI
�00. Q,► JH 04/w0t`7 '
oAki uu,rLETSa1 MPRT s 43. 50 JH ` 04/a'1/93 —
�w, ..._.. MPLC: $ 10. 88 JI1 04/20/2.):3
J C. NNLE:":+aC71U INC; M5PL f a. 10 JH 04/20/93 _
pp;l 9t 132. 50 JH 04 P) _
F-75 ,u f 6. 63 JH 04/C.19)/9 3
R 97V05
UA
�r}rs #: ,�?7' 9{33tw
'5 J I
a rw 1'U(1'Kr73r% AVi.
Ln
F1'r,Pe : C+i�'ir _r1C3 �3
46 344
>F 1574. 01j TOTAL
.5 pet-sit is i95Ued sub)eck to tho regulations contained in the - -- REQUIRED !NSPELTICINa --
iga-d Il+irocipal Co:Je, State of quo{ Gpecialty Codes and all other Foot/found Insp !#is,eplahce Insp
w
,7E'i:cotle :aws. A,k wr6 viii he done in avc snce with approved �Purst/E;eakm Strutt 1440 Line Insp
Jars. lhir peroi". will expirt if *ark Ls te' ed within 1 F'd+gt/Be+a►m Mochain ttwtulation Ihsp
ais of issue ,e, or if work is sutpe Plm/undslab Iosp Gyp Bosv,ci Inst,
PLM/Undot,frown, Rain drain Insp
r1 yrs{: 't ..r raP Mi tl, nnic:al Insia Wa+te Line Insp
Plumb Tops Out Appr/Gdwlk Insp
y w Fr,AIn.iwl9 Ins13 Mechanical F .1.nal
C:o 1 ,, for, i ri spect i un 639--417',':j
`:y
5L.WER C(jNNLC'TI(JN
CITY OF TIGARD `-r`,``'TT
pE R I'l I . . . . . . . . SwRv3- 014I
COMMUNITY DEVELOPMENT DEPARTMENT
43125 SW Hall Blvd.Tigard,Oregon 9722308199 (503)6304171
PARCEL:
14662 SW 63kl) GTG
LACK
LOT. . . . . . . . . . . . .
3 . . . . . . . . .
"iENAN'T NAME.. . . . FI X 141 URE UNITS. . .J,r�A N 0. . . . . . . . . . 11
' OWLLL I NG U1q US
LA
US OF WOHK NE-44
I Y
NO. OF I3U1LD1NC3.3.' l
PL OF Uc_7)E. . . . . :UF jMF�ERV WRFOCE.
{Zem,Arks : PATH 13
FELS
INC t y p e a m wi_t i t b y dat e ci••,r.o � �
45Z'5j SW 96TH AVE P'RMT ♦ 8100. 00 JH 04/20/9:3
N F-, j5. ijo J'14 04/20/93
97005
oil el w it: 00 TO1'AL
Re L
1 #. . '. REQUIRED 1NSr-'EC'T_1ON5
-nis Applicant agrees to tapir with ail the rules ano regulations
of the Unified Spoqp 4gency. The $*Yvit expires 160 days frvl
: i# date issued. The total asount'paid Mill be forfeited if the
Pei-sit expires. The Agency ozes not guarantee the accuracy of the
,,ide sewer laterals. If the beoer it not located at the meawestnt
given, the instailer %hall p,'OSPIO 3 feet in all directions fro"
the distance give", if rot sc locatod, the ins `e• `a purchase
a "Tap and Side Sevier' Prelit and tho! ASPi
i t t e e n a L 11 r u
CII fur RIAo639--41'75
Ln
CIO
Lail
A? 7
t f `� �
� m�((�! 1)125 SW HSM Bk-& PLNCK/RECT #5i lCHN 1 1GARD PERMIT / M5 f I_3-0/6_?
COMMUNITY DEVELOPMENT DEPARTMENT (M)&V4171171
DATE ISSUED
JOB ADDRESS: /62 -Z- 2L' C-4 TAX MAP/LOT 2-5 --SL OU Z
SUB--'421�t'L/fJG C"—S LOT: �-- LAND USE_:
VALUATION:
OWNER SPECIAL NOTES
NAME: 19- REISSUE OF:
ADDRESS: `�s,�?S` -J �!oQ— LAST REISSUE: —
7 �J FLOOD PLAIN/
PHONE: .ZZ7-�f 9 SENSITIVE LAND:
-70NTRACTOR APPROVALS REQUIRED
NAME: PLANNING: _ —
ADDRESS: _ _ ENGINEERING:
FIRE DEPT: _
PHONE: OTHER:
CONTR. BOARD #: Z-1 EXP DATE:
ITEMS RLQUI RED
SUBCONTRACTORS: PLUMB: rY) J _ : IST/SUBCONTRACTORS: —
MECH: BUS TAX:
ARCH/ENGINEEh CALCULATIONS: —_
NAME: _ TRUSS DCTAILS:
ADDRESS: �__ — OTHER: _
PHONE:
PROPOSED BLDG. USE:
COMMENTS: �__ --- - --- ---
-J
APPLICANT SIGNATURE
. f
Received By: Date Received: 11 �A / ;
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE''"
aI�310-432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5z) a0-err
Building /7
Plumbing ,,(off
Mechanical
10-433 00 Plans Check Fee o�1���
;SC� y1O- .3z
v
Building
Plumbing
Mechanical
10-230 06 Fire
SuK'3 30-202 00 Sewer Connection
30-444 00 Sewer Inspect'l:i 3�
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 / _3S v
25-448-05 Mass Transit TIF Fees j/ 0
52-449 00 Parks System Dev Charge (PDC) SZ L — -S o v
31-450 00 Storm Drainage Syst Dev Chrg
;i (SSDC)
24-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of)
1:
TOTAL ,
nm/3581P.Wf'(