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11253 SW 95TH AVENUE �� 11253 SW 95th Ave. �' w e t .r f y t , R ! ?, ♦} ,r '. V f� r `'y .t [., Y r. "7!•Sp rl ale r a{ �, iWAT s t w S 7 r?•y S 41 Aib {77Lri1P MHIi ` ,1111 77{iilt iqI S !t ia�f7i i�� ;WIM w` IMPX. �ry ••O. !{t'r7f% * ��•Y 1�. ✓'G' rh ..,e,it 7:,h . ,�sF r,�'4; - V((7 ',_''17• r #f=#77 it'kllr� i ' 7r . .ii iii b r. '3 e 4 a �,,, ��n t ,•, =,+:i o.�'' ,•(, j �{f�ia X11{ .( 111�',�i�rrri`y111i 'fa .i "N"�.In 7,y t• is A. co y y3i'h .iytp 0 0 0) 0 i Cly _$ I N M TZ, .0 1a C3 Q tio cd Fj y r'-1 Cd Cd V ` � 4-1 ? a In 1 s: tai , ! a 1'�1 C x �n N r a U � \� •� U I' �� '�'�� In T4 s?.. O I rn In u y c= N o 3 ° bq caI. D= - In 41 �'•� b10 bo w M. r47 rlt'3'1�`" ♦� Z' —t`_--'dY.Ga':74'G'11YY.Yr�1•'SYi+'' ...YLi� :':*r.�;:i3a^-Z..: 4`, `� ��.�` / y r4�r 1=�; 7� s ��r1 ' ~4 •+'a a�.r`. '�11�;Mi�y'ri' ,� r(� .,,�'t�j,.!�j=��,ryy ajr .w r,' joR O { r•`�.'44t'� i. �•••��:��•?70c`?� IFV ��� tw. r ��. �+•... ► Jt..... �� p�.r 77'I�i�Q�� �' Tom-' ."='^^.���'__i� "'.�,..•.n...n J\./\_/�,� •rrw•.A�,-��,!�.-.�-�. INSPEC'►ION NOTICE City of Tigard Buwiding Department I P.0 Box 23397 Tigard, Oregon 97223 -'hone: 639-4175 Type of Inspection �'= ���-- � r Date Requested_ Time A.M P.M. Address l' C•J _ permit,* O Owner _ ___ Lot Builder / Builder The following Building Code deficiencies are required to he corrected: 9 Presented to _ _.—.___... Approved Inspector Disapproved Date CALI, FOR REINSPECTION - a d O t INSPECTION NOTICE City of Tigard B jilding Department P.U. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Final Date Requested__9/14/89 Time A.M. xx P.M. Address 11253 SW 95th Ave. - Permit #_ attg90960 Owner_— Meadowbrook Development Lot # Builder The following Building Code deficiencies are required to be corrected: Presimted to Inspector sepproved Date _.. % CALL FOR REIWECTION YES NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4'75 Type of Inspection Mechanics 1 Date Requested 9/14/89 Time xx- A.M. P.M. Address 11253 SW 95th Ave. Permit # 890964 Owner Meadowbrook Development Lot Builder ------ Thr following Building Code deficiencies are required to be corrected: Presented to __- Approved Inspector Disapproved Date. ~ CALL FOR REI PECTION ❑ YES NO 9 I� IIJSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Pnone: 639-4175 i 'type of Inspection —G -- -- Dete Requested__ T2 i �� Time _ P•M• .Address _._� ermit # Owner221 — Lot # Builder ._. -L The foliowinq Building Code deficiencies Are required to be corrected: Presented tc, - Approved Inspector --=- — Disapproved Date -� — CALL FOR REINSPECTION ❑ YES ❑ NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspecti71� Date Requested - Time A.M.._ is P.M. Address -- d� �� � _.- Permit #22-Z-9-&� Owner Lot # Builder The foUpwing Building Code deficiencies are required to be corrected: _ �, .� 'AA v Presented to � I Approved InspectorL' �-�� L� isepproved Date CALL FOR REINSPECTION DYES ❑ NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested %y'�� 7 Time A.M._ P.M. Address _ ,I x.53 �J =--� Permit # t1f Owner Lot Builder The following Building Code deficiencies are required to be corrected: Presented to .}'Approved Inspector �L c ❑ Disapproved Cate CALL FOR REINSPECTION CJ YES LJ NO 1 �) 1989 BURTON ENGINEERING & SURVEYINGcoP:mu"tq� Civil Engineers • Land Surveyors R 302 Tigard Plaza a Hall Blvd. & Pacific Hwy. • Tigard, Oregon 97223 503-639-6116 August 8 , 1989 Meadowbrook Development 9363 SW Beaverton Hillsdale, Hwy. Beaverton, Oregon 97005 Re: Foundation Crack 11253 SW 95th. Permit No: 890964 I have made an observation of the above mentioned house under construction by Meadowbrook Construction Co. A crack has developed near the entry door in the newly poured foundation. This crack passes completely through the wall and the footing. I believe this crack was r3used by settlement of that portion of the foundation under and to the right of the entry door. This portion of the foundation contains a large mass of concrete with considerable weight bearing on the soil under the footing. I have driven a testing rod under the footing along the gall on both sides of the crack. The material under this footing seems to be adequately compacted , but contains an excessive amount of moisture beyond the liquid limit of the soil . This could cause foundation failure particularly under the heavier portion of the foundation as previously mentioned . The excessive moisture was probably caused by entrapment of storm water during excavation for foundation and construction of house also there leas apparently been testing of plumbing which could have caused water to be entrapped in this area . I recommend the following steps be taken to stop moisture from collecting in this area as follows: 1 . Provide adequate drainage for crawl space area. 2 . Be sure all roof drainage systems are properly constructed to carry storm eater to streets. 3 . Grade all side yards away from house to provide positive drainage away from house and foundation . 4 . Pour concrete stens and landing over crac'ced area and tie frith steel to concrete foundation wall . Be sure supporting material under steps and landing is thoroughly compacted. rely, Thomas H. Burton, P. F. INSPECTION NOTICE City of Tigard Buiiding Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested Time `_A.Mp, Address /-/1 --— —.-- _— Permit # _./_ Owner -�—��--i ---- Lot #_ BuilderThe following Building :ode deficiencies are required to be corrected: / 2 1 _ I EIAPProved Presented t--��1LC.L. _.. Inspector •----____ � lapprov�d Date CALL FOR=REINSPECTION U YES V-] NO W t ® ® ! NAM INSPFjTIOK NOTICE City of Tigard Building Department P.O. Box 23397 n Tigard, Oregon 97223 Phone 639-4175 . Type of Inspection -- Date Requested 1a ��� Time A.M. __P.M. Address Z/d' 513 a--5 Permit # yzo C411 Owner�� __ ___ Lot # Builder Z, AeeThe following Building Code deficiencies are required to be corrected: y V il' ' j _ l l 0 JL r � l Presenti-I to ❑ Approved Inspector _.- Disapproved Date . 1—. _zo S� CALL FOfi REINSPEMON �] YES 0 NO rips+:; vibiiu8 blspi7 30 sgY7 orn bqJaeupaq, s»a `aeta9,,. aJ n? tr. „ti3e7 r•1i: ars ar+�iatJab e.', , } iiliut3 br;iwoltni n9T �: • INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested_ '� (j Time A.M._ :P^P tom. i Address ll 5 —[-ti Permit #RI ' Owner _ _ � -- Lot # --�- The following Building Code deficiencies are required to be corrected: 41 9 J Presented to _ _ ., . .---_ --- - _ --.— Approved Inspector __ [J Disapproved Date CALL FOR REINSPECTION [] YES ❑ NO 1 INSPECTION NOTICE City of Tigard Building Depar(ment P.O. Box 23397 o Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested _____t— 2 `' r� Tim*.62-'L A.M. P.M. Address /I 2_ 5 Permit # Ov ner __ _/ Lot #_ i Bu, der The following Building Code de'iciencies are required to be corrected: Presented to rr-Approved Inspector Disapproved Data CALL FOR REINSPECTION Dyes ONO CITY OF T16A RD PEI--MT'T CITYOFTWARD PI 11,11:'T' NO DIJ890960 COMMUNITY DEVELOPMENT DEPARTMENT 011CHM 13125 S.W.Hall Blvd..P.O.Box 23397,Tigard,Oregon 97223.(503)639-4175 5/16/89 )OR ADDPESS : 1:1.253 SW 951H AVIF TAX MAF?/1-01* 1.51. 33CA 3400 SUB: I-V 6 13V I-ANL) USIE tp 1-04, sl; E V At UA I 'T'ON 5 E Ili A G K 5 F FIONT 20 Fal:A1:4 WORK CI-ASS N F.'.W DWI::11.. . UN:UT'S I EF-T 5 5 ST.M.A.J.: Filil'11LY No RFA3I:4O(,.)W-) EX'T' . WAI I COW.0* : CONST' . 'TYPE VN NO . I:::()I Hi P N: G : F W OCCUP.GRP . P13 PIF401 . OPV'.NTNGS : OCCUP.LOAD N - S : E W : At Al--W.A 11. 0 NO . S*TOP.I'+'.S 1. JA-)'T 1 120 PO(JF` CONS'T : C F*114E FIE '1 7 HE 1 GH'T J.EI ;..?N D APE'A SF:PAP"? IWTED : BASEMEN'T"? 3RD : OCC'UP . SEPAR"? 14 MI: ZZANJ'Nl:.:'? RALj[.::M ...00R I-.0A0 10 GAPAGIIK ! /Idlio F-T PE SPIPIKI.-P? At A 1:4 M hjF--&T TVDIT --F I.A]w DETECT7 YF-S F'I-AN G.1--IF:('.I< BY : PE'MAI:WS : REISSUE: OF' NO. 881707 LAST' 0 FF.KES W N ANDERSON DEIM AN E PE �.-2 v.,5 . 00 E 9363 SWPLAN PEWEW $40 . 00 R Fl:pl.:: I3I:::P*t 5'MTEE TAX C (YrHE-KI-4 0 IJE:-'V F:L,0 1)M FK'N'T CHAPGL::S : N ANDIL:.PSON DAN Iii. SUC(S1,0WIVII) *250 , 00 T R livili-ADOWHIP10(J1K I'.)F-:VLI-0PMFKN1 SDC 1151,PKE:1 $600 . 00 C A 9363 sw Hr.-*.:Avi,-':Vl'l'UN---l-IT.I.-L.'-,I:)AI 1::' 11 $250 . 00 T bpatvv�rtciri at', 97006 PPE.PAID < $40 . 00) 0 11"'HUNE (503) 297-7666 R I REGISFRAIMN ISILL 463�14 101 AL.. : $1. AJ()10 This Permit is issued subject to the regulations contained In Title 14 I1r--CI:.A:P'T NO. /eq Js of the TMC. State of Oregon Specialty Codes, zoning regulations ................ and all other applicable codes and ordinances, and it is herebyU.r.p - agreed that the work will be done In accordance with the plans and INSPEC'TJ ONS specifications and in compliance with all applicable codes ani F*VY1 I.NGo siliKWiM ordinances The issuance of this permit does not waive restrictive FOUNDAI'lON WAI.J... RA1N DRAINS covenants Contractor and subcontractors shall have Current city P051 ti REAM WATE.1141 LINE bi,siness tax permits This permit will expire and become null and UNDEW:il.-AB CITY APPPCH/!iw void it work Is not started within 180 days.or If work Is suspended or til A I."I F-1 NA[- abandoned for a period of 180 days any time after work has commenced It shall be the responsibility of the permittee to assure PIL.B . Topour all required inspections are requested and approved 1:44WING Fr 1 Aft.V-111 ACE GA'-.) I-TINIF* 1114151.111LA'TION Perm,�fee Signature GYP- POAPD Issued By CALL. F'0A INSPECTION 639-4115 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE PLUMBING PERMIT C'TY OF T'GA RD 1:�I.,-NMI'T NO . : PI-890963 C ffp—OF IjWARW COMMUNITY DEVELOPMENT DEPARTMENT oegaDN� [)A1 U. T SS U E,1) '15/16/09 13125 S.W.Hall Blvd..P.O Box 23397,Tigard.Oregon 97223.(503)6394175 PAI PM'I* .NO. (390960 J013 ADDIRIESS : '111.1c*2,1`3*3 SW Iii 01-1 (.)Vl;:* 'PES L T d) U�K TAX MAP/L.01' V:)J. ".5-100 SAJF: : m" I AND USE'..' 1:41P 1-01 N(] W.) WOPIK CL.A5S : NE.:W WA'T'T:k t::l 05F-T A P USI X : STN(.;l K- F Y UNINAl RK111 OW PI-WN'T14 (.'0N!5T . I Yl::'F:: VN L AVOPA1,0PY F-1W.LME.-1:2 0(:Mlip.GPP. 1:4,15 11JI:_4 GIA01AIL-14 DISIDOSAI 1 N0 S1 0 P I E:S I WAS-1.13*NG MA(:, -IINE. 1. I -)tJNI.)I:',Y Y'PlAY 1:31..1:).; . DPAJA DIA 1*.)Wl:..l I U NIA'S I e FA-.-00l:',' DPAIN S INK I S-1EMEA (F T WA'1'1::.n FIVAIL.0 I STONM/PAT IN1 (1-I* a. 01*11-IIE-14 0 ONL)Ir,:WAIN DAN I-': PEAM I T 16'1.1.'7 . ;`.50 W N (9 363 SW 1.41EAVEATON HTI LGDALF R E b ei it&v va r-t t;j ri Or' FIXI UPEs' !iiTA'TI*- 'TAX $3 Will HE C 0 N WOLCOTT PLUMBINc GONTIIS INC . I H P(,.WII:)XR72 Arrt6111►m0P 97030 T PHOW (503) 667-1781. 0 lj4rm.w3'T-wn'1JA-.1N NO. 231113,11-7 R J'UTAI $123 .38 WAA;.11 NO . 3 This permit is Issued subject to the regulations contained in Title 14 of the TMC. State of Oregon Specialty Codes. zoning regulations RE-EQUIPEJ) INSPECI XONS and all other applicable codes and ordinances, and It Is hereby agreed that the work will be done In accordance with the plans and 11A.A.UNDE:,PSLAS specifications and in compliance with all applicable codes and POST & 131F AM ordinances The issuance of this permit does not waive restrictive WATCH LINI:--' covenants Contractor and subcontractors shall have current city P1 F.4 .'rCIPOUT business tax permits This permit will expire and become null and IIAIN DRAINS void if 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 FINAL. L. commenced It shall be the responsibility of the permittee to assure all required inspections are requested and nppruved. Permittee Signature Issued By SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE CITY OF7167ARDF,E.1.1,MT F N I I i E:0 9 0 9 65 CITY OF TWO J) COMMUNITY DEVELOPMENT DEPARTMENT 011100N :1.6/69- 13125 S.W Hall Blvd.,P.O.1'ox 23397.Tigard,Oregon 97223.(503)6394175 he TM 'T . 0 P1 N 090960 JOB ADDRIESS : 11.P!-.i3 ',,W 9,511-1 ()Vl::. I`-!LJMJ;)I:J4 : 0;37.31/' rAx MAP/I (:)I* IF-il 3'(100 'A.)B ! 6 E11K . LAND USE : 11:�,I i-! L.01, 51:Z11'..: %`:C'VION: 33 T'Wl, :1.ci FMG : :I.w WUWK (::I-ASS : NEW tist-'. *rYPi::1 : STNGA-E FAMA-Y 1,11-le tc) CI:)InI:)1y Witl-) iti,13. l5ewel—fiLue pell-mj.t expirec; V".20 1:)e Tc)r-I`t)J.t.0d if the) p(.i?I-.M:Lt AcIc-!rir.y (:I(:)ei:; ricit c Of ti-iii? lootitti(3n 4:)-P ti-io. %ide. sewer luLtOl"RAM . '.[:-f' LI11P- viewczr• J.!r, iicii. lemmi.ed iit,t. ti-if., m(.?i;tmLtr*PmcPnt giiwori , ti-ir.-% irimtiallp.r mhull. 1:)rcis;r.)ec1, 3 fc.itri)-t. irl iall dirm?cticfri% -Frmjvl the ditstattif.n*7.1 given - T-F I-Icit %c.) luc!iated , M-1c.? i1krid 5:1.de Fiewel-11 Prerinit aired the Agericy wil]. J.rI1i;tl:IJ.I. Ill. Tiatel,1:1.1 . 119SI'ALL. 'TYPE: PUTI-DING SEW.F:P 1MPI'--.AV1OUG APEA: 1.1N:r1,S : IFENANI' 1MPP(:)VE:-'MEN'T : DWI:'11 LTNG UNITS : I NO . 01-.* 81 DGIS . 1. 0 ANDERSON DAN E P F"P MT 1' $ 315 . 00 W N 9363 551141 SEAVIF-11- 7-ON-1-1111 LSDALF. GONNIIA7*1`1UN CHOPGE Ail , 100 . 00 E b oi m v e?I--t u n C)I` I'AP :ENS'Y'Al L R 01 hlt lI C 0 ANDE11:49K)IN D A N E N mr-i-ArnmBROOK DI::-VIF.I.-0PMEN1- T R 9363 SW A 1:)(.1?1&V a I.,t Lf 1,1 cir 97006 C T (.503) 2107-7666 R 0 NO . Z1163414 l'OTAL. : Ail , 135 . 00 PE CE NO. This permit is issued subject to the regulations contained in Title 14 of the TMC. State of Oregon Specialty Codes,zoning regulations r-t.'QUJI-NED :I:NW)EC,"TJ(:)N5*) and all other applicable codes and ordinances, and it is hereby POUGi 1N agreed that the work will be done in accordance with the plans and specifications and In compliance with all applicable codes and ordinances 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 if work is not started within 180 days,oritwork ISsuspended 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 inspecIfiXt;are requested and pprovecl Permittee Issued By C A' -t:-LW 1,N 6 P"LIX 3;CIN 6 410 A SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE M F CITYOFT17AD W ERMHANICAlPER39M0FII'TNO MEJ191 6(I rTpARD COMMUNITY DEVELOPMENT DEPARTMENT Otto DA'T'E: 'I*.!55LJ1::.D : i/'16/89 13125 S.W.Hall Blvd-P.O.Box 23397,Tigard,Oregon 97223,(503)6394175 P F11 M . ISM 1' .NO. 890960 JOB ADDRF"55 : Iii-R1,53 5W 9'"YFI-i A. vl::-, T()X MAP/L.(')*l 1.51. 33CA 3/100 SOW T A(: P'E�':) I-A* : el RK I ANI) USLK : 1:11. I ()'T 51ZE: NO NO : WORK CLASS : NF.:'W FURNACE.K. ('100K I A14*4 VIANDI P <1.0 USE *]*YPI:-- : S:LNGLI;:: I-:*AM:[I Y F144NACE 1.00K+ AIP HANEA-P 10K CONST .TYPEK: VN F1 F(JPNACE F:V 01CLUP.GAP . : P"s HEATEP V1:;7JT FAN 3 Vl--_:N*I* VI::N'T' . !'-iY!':i'TE.M EILA/COMP <31-11-) 1-1001) :1 NO. STORIES : :1. RIL.P/COMP 3-1.51-11P 1N(.JNF1:4A'T`(')P(0(:)M DWELL...UNITS : 1. 13L.WCOMP 1.5--30HP J'.N(:,'1:NEPAT0A ICOM FUEL. TYPE GAS DLA/COMP 30-50HI) PEF)AIP UNTY ") MAX . ]:Ni*-)IJ'T* Bl.-P/(*.(:)Mp 50+1-117 L2 FIRE CIMPIRS? ('.1AS PI:P'I*N(':,. O(.l11 F.E.TS 1. HIGH PREESSI? LOW PIPESS117 ALKMAPKS : 0 ONDLPSON DAN L'. 1:-E:PMI T 14110 . 00 W N 9 36,3 1:iW BLEAVEATTON HIL.L!511:)ALS.'� PLAN REVIEW1411.0 . 1. 5 E bfA�a.ver,tciri 011 F,3:X r tj PE 91 $30 .30 G TATE 'TAX $P . 02 0 T'HE,P C 0 N ro C>; T R A C T 0 TOTAL : $52. 6.0*) WEC'EIPT NO. 163 This permit is Issued subject to the regulations contained in Title 14 .......... »••• •-•-•••• ••••••-•-•••••• of the TMC. State of Oregon Specialty Codes,zoning regulations VIEQUIPED INSPE(.-TIONS and all other applicable codes Find ordinances, and It Is hereby GALS LINE agreed that the work will be done in accordance with the plans and specifications and in compliance with all applicable codes and POb4' & 141:.:AM ordinances The issuance of this permit does not waive restrictive PL)L)('-'PH---T N covenants Contractor and Subcontractors shall have current city 1: ENAL 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 commenced It shall be the responsibility of the permittee to assure All required inspections Are requested nd approved Permittee Signature Issued By- --mA 'NGQ&nTTG01 6-29-4-1;tn --- SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE c/G 3Vq CITY OF TIGA RDr:a�� PLAN CHECK APPLICATION CnYO(TwARA PLAN CHECK U /- yeA" COMMUNITY DEVELOPMENT DEPARTMENT l PERMIT N RIO`alp,' 13125 S.W.Kse8jd_P.O.Bax27J97,1iy�QO�cQor.977I].(567)6?9�1T5 -7- .�/ DATE ISSUED JOB �ADD�RES�S: ;l07 5-•� �t-CJ SI Q� ' / �I AX MAP/LOT /.5/--3;C 4 3(let SUDxT�� -- _ LOT:- - V� LAND USE: VALUATION: _ OWNER SPECIAL NOTES NAME: �i,Z _�, _ REISSUE OF: ADDRESS: ,�3 •�ti'`�t- LAST REISSUE: FLOOD PLAIN/ I SENSITIVE LAND: PHONE: — Zu APPROVALS REQUIRED CONTRACTOR PLANNING: NAME: _ �ra`G J ENGINEERING: ADDRESS: FIRE DEPT OTHER: PHONE: ITEMS RE9UIRED LIST/SUBCONTRACTORS: ARCH/ENGINEER BUS TAX: NAME: CALCULATIONS: ADDRESS_ TRUSS DETAILS: _ PARKING PLAN: LANDSCAPE PLAN: PHONE: OTHER: _ COMMENTS: r X-C — 4 1 jg I,i PERMIT N ACCT N DESCRIPTION AMOUNT AMOUNT PD. DAL. DUE Yyvq(Lv 10-432 00 Building Permit Fees off 10-431 00 Plumbing Permit Fees ti 10-431 01 Mechanical Permit Fees 10-230 01 State Building Tax (5X) Building )IJ, 7S Plumbing Mech 10--433 00 Plans Check Fee Building Aj Plumbing Mec h / U__LJ—_ ? yHs 30-707 00 Sewer- ConnecLion 30-444 00 Sewer Inspection 2.) 51-440 00 SLreet :system 0(,v Charge (S[1C) 52-449 00 Parks System Dev Charge (PD(:) 31-450 00 `•;,or;n Drainage Syst Dev Chrg (:SOC) 1 aD 10-730 09 TRI"D 10-7.30 OG Washing Lon CounLy [ire N1 (95X) 10-220 00 AmarL/Wedgewood T7, JF APPLICANT SIGNATURE Received Hy . �l5.1�'t _ _ DaLe Received: cn/3587PI1011