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INSPECTION NOTICE City of Tigard 3uilding Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection '^ _ _ _ Date Requested + -)— -1;; - Time , A.M. i--, P.M. Address V Sw'itJ flZ� �''^ �•/-J _ Permit # a Owner /,. /tiff�� Lot # _ Builder /- e/ � Ie &-.e - --The fo!lowing Building Code deficiencies are required to be corrected: _fir MiA v --- 1 7Q1'1�� Presented v, _ __—t ❑ Approved Inspector "` ❑ Disapproved Date =-.�- f 4 CALL FOR REINSPECTION ❑ YES Cl NO MECHAN!'(."Al PIERMIT C ITY OF TIGA RD PEPKI-T NO . ME.890962 CITY OF TWAIM 091FGOPO COMMUNITY DEVELOPMENT L)EPARTMENT A 11)(I)TE: I's5k.)ED : n/27'/(i9 13125 S.W.Hall Blvd..P 0 Box 23397,Tigard,Oregon 97223.(503)639-4175 --- 108 ADDPE:55 : JA.U.'10 5W -1.00TH (VA::- IAX M()P/l (:)'f 'AJU: 11.11L.A.Gl< D'IAMOND AND L1 ah: 1 (34 !aLir:. ITEM WOW (:'LA!;0:i ' NEM F-1A144ACA'. <100K AAA-! HANDL.14 <1.0 IJSI:.: l'YPr7.: . !iINGLE FAWIA Y F I)PNOLIE'. 1.00K.f. '1-0K 'I Yi::11::. VN FLIPINAGA.:.� F.14 0 1 j I':' C."1:4 1:) 143 1.-11.:'A 11::R VE.N T FAN VEA 1 VJiJ4,1 Sy!.*1jrF':M OW( 1)OM 1."15••.:501.11' PF' U"C"MV, 310..."501-0-1 PA.1.1:4 UNI. 1 IHIA.11* 1::;1 1:",J(.;0MV1 '504.1-11P 0 1 HEIR 1. P I,,I!!i UmNii P11PING, VV $1 0 N I I I W I Aft] (10L. I 0"j (:w III 0 N T R A C T 0 R I VOL. : $15 This permit;a Issued subject to the regulations contained in Title 14 1 ....NO 4.0 of the TMG, State of Oregon Specialty Codes,zoning regulations And all other applicable codes and ordinances. and It is hereby agreed that the work will be done in accordance with the plans and specifications and in compliance with 811 Applicable codes and ordinances 1'he issuance of this permit does not waive restrictivp 1 li I f') covenants Contractor and subcontractors shall have curr4nt city business tax permits This permit will expire and become null And void if work is riot 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 rmit Pe Sig Issued By ell SEPARAJE PERMITS REWIRED FOR WORK OTHER THAN DESCRIBED ABOVE 1 City of Tigard 13125 S W Hall Blvd. MECHANICAL PERMIT Rermit -- P.O. BOX 2.3397 Permit tr_ ��`� � �� Tigard, OR 9722:3 Description — 639-4175 Table 3A Mechanical Code QTY PRICE AMT VJ 1) Permit Fee -0- -O- 10.00 ^- Name of 0 velopment �- -- - 2) Supplemental Der mit _300 Job Address ti --- 1, Fumace to 100,000 BTU - ind.ducts 8 vents 6.00 Address _ )C� S•U- --- - 1 -' Furnace 100,000 BT(I + Tu Lot Map No. - --- 2) 7.50 incl.duds&vents - lot Skid Su"Vithul -- ---- Narne(or rw w of bu*wn) - --- --- 3) Fir Furnace incl vent 6.00 Mt1�r10AddnssSuspended heater,wall heater Chvner 4) orfkxx nvuntedheater 6.00 City/StateZIP -- 5) Vent not incl.in q appliance permit _ 3-00 Repair or heating,refr' 6) �•� -6.00 I _ cooling,absorption unit Address Phone 7) Bo;Ier or comp to 3 HP J 6.00 absorp,unit to 11710,00011TU I Occupant City/Stale 2,p — 6) Boiler or comp to 3 HP-15 HP absorp.unit to 500,000 BTU 11.00 --- Na," 9) 13oilerorcompl5-30HP - „ . ,-1 _ I Y y y(C*{�� K _ absorp.unit 112-1 mill on --- 15.00 - 7�0 A Address �" � S3 Pt%N* 10) Boiler or oomr.to 30�'Sn HP 222.502 Contractor `- J absorp.unit 1 1.i 5 million CMY/8faM Z-013 11) boiler or comp to 50 HP 31.50 absorp.unit 1,750,000 BTU mate taayhstratlon No. GA Bus Tan,.o. ) Air handling unit to 12 10,000 CFM 4.50 —1 Mreby adutowlsdpe that 1 have nae Crs , Air handling unit R app"tom that thio intomalim gtmn is 3) 10,000 CFM + 7.50 oort+ct gat I nn Na owFw d authorized agent d or the own ,that pian,submitted are h oonpfarxn""'Stals laws,that I am registered with nb Stets PA4ders'Roane,that the Non portable nuns 91"n is coned.(it estt 0 Irom Stale registrahon please give reason Iblow). 14) evaporate COiib• 4•='0 - ---- -- -- _ 15) Vent(an connected --- - ------ to a single dud 3.00 — --- -- - --- -------- -_-- Ventilation system not - ----- a- 16) included in appliance permit 4-50 Hood served by — 17) mechanical exhaust 4.50 (owner«agerq . —onto Domestic type _ Describe work ---- 18) incinerator 750 O addition ❑ alteration O epair [-I to be done residential O non-residential [') Commercial or industrial 19) Existing use of _.�._-.— type incinerator 30.00 building or properly _ Other i e.,woodstove,water Proposed use of 20) Other solar,clothes dryers.Or 4 buckling or property—__ l — - -- -- -- 21) Cas piping one to tour outlets 2.00 Type of fuel- oil O natural gas ❑ LPG ❑ electric n `_'-`_..--- 1 '_2) More than 4-per outlet NOTICE THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON- SUB-TOTAL STRUC71ON AUTHORIZED IS NOT COMMENCED WITHIN 180 5% SURCHARGE DAYS, OR IF t;ONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER --- WORK 1S COMMENCED. TOTAL Special Conditior s '01LJ INSPECTION NOTICE 1M City of Tigard Building Department P.O. Box 23397 l Tigard, Oregon 97223 Ph-one: 66339-4175 Tv,-w of Iospecti.m Date Raquested L _ Tl me c�6' A.M.( C I� P.M. �� �C� . Address _ - Permit own•r l Lot #_ Builder The following Building Code deficiencies are required to be corrected: 04r C Presented to _ I Approved Inspector _ -- �, Dt%approved Date ��-� - CALL POR A,114SPECTION NO 1 INSPECTION NOTICE City of Tigard Building Department r, P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection iT 1-�—•— Date Requested LI 4 Time A.M. P.M. Address ��l Z rG� Permit # �� Owner__ Lot #_ tt Ir ( YY1 cY L'14' < Builder l y / J The fnllovuing Buil ing Cao a ,deficiencies are required to be corrected: Presented to Approved Inspector - U Disapproved Date - .f ---- CALL FOR REINSPECTION Cj YES ❑ NO i INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 1 Phones 639--14175 h Type of Inspection _ �Q r �► l Date Requested Time_ A.M. P.M. Address < < 1 C) Permit * O l Z-- Owner _ Loot #_ Builder O�r �-� 7 ,IS 7 4 The following Building Code deficiencies are required to be corrected: Ole- Presented to _ `-Approved Inspector ❑ Dimpproved Date CALL FOR REINSPECTION ❑ YES 1�1 NO INSPECTION NOTICE City of Tigard Building Department n P.O. Box 23397 Tigard, Oregon 97223 I Phone: R39-4175 Type of Inspection C Date Requested / Time L) A.M. P.M. Address �/1�z7 ft ��'� Permit # Owner Lot Builder- The following building Code deficiencies are required to be corrected: !.� 'e A 56`11 /LOW 01 i Presented to _ _ O..Approved Inspector _ ❑ Disapproved Date _ CALL FOR REINSPECTION (�] YE8 ❑ NO F INSPECTION NOTICE City of Tigard Building Department P O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 .1 Type of Inspection _ ..�– •"`' ` � —...�— --- Date Requested gG� Time A.M. P.M. Address __ C) Permit Owner t-4�-�r b M Lot # Builder The following Building Code deficiencies are required to be corrected: Presented to _— ❑ Approved Inspector L-unapproved Debi CALL FOR REINSPECTION E-1 YES ❑ NO r INSPECTION NOTICEC }� f 1 A City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 ( Phone: 639-4175 h Type of Inspection Date Requehled Z —2- Time A.M.. PINI. Address IJ 17� ( Permit Owner�. — S 5 Lot # Builder The following Building Code deficiencies are required to be corrected: ``' ' Presented to �� _ _ El Approved _ Inspector `�. n1 _ ." ✓� 0-M proved Date _ r:I1 t. Ft�R REINSPECTION M YES r I NO UWIIRM C'7Y OF TIFRD w ERYI I DIN(.vHPE89WFT PjF.-ERKET NO . 00 1-El croFRvP 0Go" COMMUNITY DEVELOPMENT DEPARTMENT DATE. 1. /2'7/99 13125S,W Hall Bivri.,P.O.Box 23397.Tigard.Oregon 97223.(503)639-4175 H-:1.M. PMT .NO . ('119001.8 1.0811-4 AVI;;- TAX MAP/L.01, 1.5 1.3,01 D A P A P'T '1.9 0 1. 51.113: B L.A C,K D:I AMUND L.T . UK 1-1-')ND USE.E. : L.01 GTZE: VAL.UAl LON: Ill .115 Al ,682 5[:-TUA('.;KL4 20 PEAIM: 1.:a WO171< N!;:.w DWEL L. . UN:I' V5 L.F.:F-T 1.0 AIGHT : 30 y NO RE.-E POOMS : :3 E.".KT ,WAI-J 7 W NO . CIONG V . I'y 1:)I::: VN N PAC)'T .OP).:'jr GAP . A3 -N1'.NGn : LOAD N "I'M At A1: E:A NO . 5 fOWEEKS : :1. 1.S'T : 11.175 I.40(:)F* C'UNST : (111 FJI;IE PEA-? .1.6 2ND: 1"16'1 r..:.U : HAGE'! I-EN'T"? 311- D: Oc"C'Up. !FIEr, PA T'I*-*..I): f:A rii 1:-::M 'I W..'.Z Z A N 1 N E:? 1:1-00P L.OAD: 10 -4100 FTRE: SPIRKI-117 Al..Apml? F'I Ow(('."IPM) YF:S) HLOT TYPE: (;As I.-K)UP PLAN F-Y 1-1 OF NO . LW.'0' RE155UE 0Ili�.29H 00 W M0 1:111.Ci U. I'T F. ANI) W, - N :1 0/100 '.W AL 1..I::N Ell...Vl) Ill I 9A '10 E1; A V F*1:4 113 N 11,111 f AX 4i 1.dl . 90 J! C 'I'MEKNI CHAPGOE.-!*-i 0 1.1c)r'. iii::I 'T v., ONO PAI 00 N 111600 . 00 T I-1V 1.4 1-4 M0 PS 5S 1�:. 1 117. 1:1. I)Pl.i 'I rit R :1.0,q()0(a14 61..1. j::j. V IA $2250 . 00 A C ON 01:4 WOW`.) P I I pi. AY D < Ili L00 . 00 T PHONL. ( 503) i.-�,(16 k:030,5 0 toll. 1 1.5 0 6. d)0 R (-1V:')*Tr1(-0-I'(')N NO 6*09F.) L PL'c;U :i'PT NO 102- 3-2-7 This permit is issued subject to the regulations contained in Title 14 of the TMC, State of Oregon Specialty Codes, toning regulations and all other applicable codes and ordinances, and it is hereby agreed that the work will be done in accordance with the plans and W-14 specifications and in compliance with all applicable codes and I I It!01)( I I UN WAL L. i.1 N DW AT W5 ordinances The issuance of this permit does not waive restrictive 1,0`1 1 & WEAM Wr-A'k*.*.P I-I.NL' covenants Contractor and subcontractors shall have rUrrent city H I INI.A,;WM-AU.4 I y A 1:1 V.,1-4 C I.1 91 W business tax permits This permit will expire and become null and I I-1 N01 Yold if work is not started within 180 days,or it work is suspended or abandoned for a period of 180 days any time after work has f 1.111'4 IlYf commencejI It shall be the responsibility of the permittee to assure141 - all requip6d, it spections are requested and approved l 1.I If I I. 61 ON Permittee Signature Issued By R7 rrtr I 1 17 1, 1 1 1 1`11-7-17' .'__7T1 SEPARATE PERMITS REOUIRED FOR WORK OTI-41ER THAN DESCRIBED ABOVE GEMER 1*4i'Pt-11 T C17Y OF TWA RD NO. : CITYOFTWAND DATE I55I.k.10i: I/127 89 OAfOON COMMUNITY DEVELOPMENT DEPARTMENT F-1111M. Plm'r.NO . 890011 13125 S W Hall Blvd..P O.Box 23397.Tigard.Oregon 97223,(5G3)639-4175 JOH 13.1.20 SW 10EYTH AVfr LJ5A NUMBEP-4 : 037V73 IAX MAP/1-01' .1 Lis:1.31DAPADI"J.901. U lk-� . 111.A("K DIAMUNU 1. ANU UILE: 1. 01' SIZE : SECTION: 3/4 T'WP : :I.$ PING: 1w WORK G'LASiS; : NEW USE 'T'YPF.:: : $INGLE F-AMIL.Y The tc) with m.11. r,mleiri airid C)Clio (:).f .0-1foUnifiecl 1512wer-agcr. T'he r)vr,mit clai.yto fi-am the d&-Le intomut.d . T h(a t(:)t I&I ACTIC31.11-111 Will. 1.)e 4'01-4'e:11A.0itJ if 'Llie PCOI-111J.-It, expir•eos . rhe Ac*iric;y dc)eot ricit rjt.imr— (nlitc.10 thel tha, lcicoktinn t3f •the) iu:L(J(4? lo41weC. 1-F t'he) lsa;!W':wr- its n cl t' .1.ri C.'m t e d a t t.her in ca PL%LI C'6.4 10 61 I'l t V 011-1 , f,ti*a :1.ri lit r.at'l.:1.(a r- to 111iL 1.:1. p t, ;3 f010t. Ji.1-1 dii-sr.c-t.iarim -Fr-(:)Cn t.ha cliffitance Jjiverl . IF 11(3t, ton 'Itn-flitad ' the irlstpiller, 1101413.1. M. "llcl Side StowcP1.01 Pkvpl•rnit Co.ricl -01e Acjerlcy will lok-t'el-ifll TNS I MCI— . I YPE 11`1 Pfl-H V.I.ULP:1 AHE:A: l*:':1:XT1JPE UNITS : IMPPOVE':MENT : OWE I LING UNIT$ NO . OF OL1')G,5 .1. J M(:)P:15C.iEA'TE.: 1-11-.311, AND VJA 1435 . 00 0 W 3.0400 15W ALLEN 0-VE) ('.'1ONNECr1(:)N $1 , 100 . 00 N E MI'AUEJ41'ON Op LANE I'AP IMYTALL . R C M 0"I SiS 1*:,1 11::- 1_11iJqt$ )141.) 0 M0l:'�J:!5GE.:'Y'TE EIILUA�. . INC T *10/1005W AL.L.EN rol-VO R Rr::AVE1:YY'ON 9,7005 A C PHONE: (503) c�/116 0803 0 T PEMU-5T-1110-110114 NO . 6298 'T*0 T*011.. 111111:11. 113105. 00 R PF:CE:TP'1 NO . ....................»........ This permit Is Issued subject to the regulations contained in Title 14 of the TMC. State of Oregon Specialty Codes, zoning regulations and all other applicable codes and ordinances. and it is hereby 174011*A-4 IN 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 ciermit will expire and become null and void if work is not started within 130 days,or if work is suspended or Abandoned fcr a period of 180 days any time After work has commenced It sha!l be the responsibility of the permittee to A591dre all required inspections are requested and approved I Perm ;ttee Slgnaiure f;*OP IN5PEC1*1014 Issued By SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE IIIE'U"IANXII'Al PEMMI,l PIE:P*111 I' NO . IME:'8901,112 %oil Y_ OF T16A RD CTYOARD DA"FE' TS5I.AKU : .1./27/89 COMMUNITY DEVELOPMENT DEPARTMENT PM T'.NO , 8900:11.11.1 13125 S.W.Hall Blvd.,1,*3 Box 23397,Tigard,Oregon 97223.(503)639-4175 11. 1.;!O !*.iW 1.0811-1 AW:: 'I AX MAI'; ; ().I SLID: 1:91...61('.:I< WLAMOND I LAND U!:ii. Lnl NO: NI I 6,1101:41K 2LAGS : NE*W F't,Ir-4NA1'.J.:: <1001< 1. A11:4 FIONDL.R 0.0 I-ISE: TiVE: SINGAA:: F*AMTI.'l` ATR HANDLO 1.01< VN F'I 001:4 PUPINN'.1ki. liEVAP .COOL LP -11'')TE,1:1 V "N'T' FAN VENT VENT . GYt-'i'I1*:M 1.31 P <3F11 FOOD NO. 1:: JI 1:4 C 0 M 1 '3 15111L*' :1 N C'T N Fi:A A I'D IP4 D I'.I M 17WI-111... . UNITS U1. 1.'4 C10MID 'A li 141.44 C 0 1`11%, 3 HI PE:Pr- 11:4 UIS11TS TV-111-': G I MAX . TINPOU'r 0 1'1-11:!'1:4 Omr'ns"? GW, I:*.I'J):I:N(.', (JI.JTI li; LOW PF'MAAK!'5 : MON 1.S!5E.I''VE, HE 111113 OND I,t, i 111:10 . 00 0 W 1 0/100 Sw N I [J4 Ull'..Vl) AN HF.W.L.W 4110 . :13 N F:L'o V F:1:4 I'D N 0 1-.1 1X It AW.S E *30 . :'10 R I All 'I AX !It 0 C M0 l' I ''ON I.-I I I 1-1 V. 0 FVING . N T 1 Ix R is q A T 1 'il'PA'T '1,014 NO . '1'01 AL. : 0 !115P. 65 R PF.('A::TPI NO . .......................... .................. This permit is issued subject to the regulations contained in filli-I 14 of the TMC. State of Oregon Specialty Codes,zoning regulations 1 11 IL 11 NED TN1:;PI:..(.;I :11IM:) and all other applicable codes and ordinances. and It is hereby 1,1141; 1. 1:14, agreed that the work will be done in accordance with the plans and I (,I!:i I IN, specifications and in compliance with all applicable codes and It IT!"I 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.or if work is suspended or abandoned for a period of 180 days any time after work has commenced It shall be the responitibility of the permittee to Assure All raqLA d inspections are requesfM and approved Pptmi tee Sigr4turr Issued By I t-VA-11k:I.:I 10N 6'A9---X4J. t.".$ SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE W W N W N N PI UMEUNG PEPM11'CITY OF TIGYAD � PE.AQ41T NOPL8901. 11. CITY OF TMO COMMUNITY DEVELOPMENT OEPARTMENT DATE 15!-AJE:D: :1./27/69 13125 S.W.Hall Blvd.,P.O.Box 23397.Tigard.Oregon 97,�,23.(503)6394175 V,WE M PKI, .NO. 69 0 0 1.a -Jon 11.11A20 SW 108,11-1 oVE: lox MAP/1 01' IS1"341OA PARI 1.190:1. SOD: DIAMOND EM : i-ANO LISVE: NO : NO: worm NL::W W(-)'T'I,-::p (::1_(:115E.' , TPAV' I.-JIUL" TyPri-l'.: 15TINIGLE I-"(-)M:Ll Y UP]NAI 13110LOW l:,I4VN'T'P UN I ALIONA1,011:4Y 1WAV, 1*44,1MEA P3 TUH SIAL)WEAR a GvPCASI' 'T'POP'S D1 SHWASIAIL"A :1. NO . S11*0I'-*4J'I:::Si 1 W(-)!:114'1.N(:, OWL-A L tv I 1'!3 1. I AUNI)PY T'R'AY 13LAX"s . IDPATA ( 1),h) F!1. 11:4 DWAIN �W/IRAX.N (I' ( WrIVIEP Cs ' 0 1 ll::.*1:41:-..' AND P(0 W N 1.0"100 !:iW B1 V I) E R D DAVE.VI 10N (11:4 F:11,X,1*U P 1:;: i:i*I*A'1*1:;*. TAX 01,11 IF44 C 0 ('i 1--10 E:.M A Is E.P 14APULD N T r-iol-110EMAKE.14 !.i PI.A.0101 NC, A R 1:1 el 1::0X C 9'70P.'' T 0 MY ',19Pi.? f t 1 I AL $1.P'3 30 ''T NO . /012 7:) chis permit is issued subject to the regulations contained in Title 14 ................. .......... of the TMC. State of Oregon Specialty Codes, zoning regulations I'l N 0 r�I and all other applicable codes and ordinances, and it is hereby agreed that the work will be done in accordance with the plans and specifications and in compliance with all applicable codas and 1!i V ii. Pit AM ordinances The issuance of this permit does not waive restrictive (JA f 1.1 1 J.Nl::'. 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.or it work is suspended or Gal lN L)I:IAJ:N!i abandoned for a period of 180 days any time after work has 1: '1 NAL commenced It shall be the responsibility of the permittee to assure all required inspections are requested and approved rermittee I ignature Issued By T Ill Mr 1:7., 1 011 1.)717 1.1 7 z. SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE PLAN C111.1;1 APPLICA11011 CITY OFTIGARD PLAN CHECK 0 COMMUNCTY DEVELOPMENT DEPARTMENT PLRMT'I* N 1312S SW"mp apd p.0.F�m 23w.pumA oragon VrM ISM)6*4175 DATF ISSUED f04 JOU A00111 VAX MAP/Lo r S4)� 1al ' 04,1 LCI 1 AND U,:( ........ Vol (101 IIJ OWNER SPECIAL N01 : NAME: el 7 b LASI REJI'SUE: ADDRESS: IZZ-4-7 A. FLOOD PLAIN/ SENSITIVE LAND: - s REISSUE OF —f 710-�E-: APPROVALS. REQUIRLD EQUIRLD CON YRACI-OR PLANNING: NAMEFNGlNI-( RING: [IRE DEPT ADDRESS: MS REQUIRED F-��HN . LIST/SUBCONTRACTORS: ARCH/ENGINEER BUS TAX: CALCULATIONS NAME: ADDRESS: I-RUSS DErAILS: PARKING PLAN: LANDSCAPE PLAN: PHONE: OTHER: PERMIT 0 ACCT 0 DESCRIPTION AMOUN I AMOUN I P0, IIAL, DUE" Taj2o(?�_ 10-432 00 Building Permit Fees ��>�_._ _ -.-.- .- All 10-431 00 Plumbing Permit Fees --/-�•I.!" 10-431 01 Mechanical Permit Fees 10-230 01 State Building Tax (5%) a 2.01- Building Plumbing moch 10 433 00 Plans Check Fop - Building 3 1,23 P 1 urub i rig ? Moch ?q_oj 30-. 20? 00 Sewer Connection 30-444 00 Sewer, Inspection 51- 448 00 Street System [),.)v Char,gsl (SDC) S2 449 00 Parks Sqstom Dov Charge (PO(,) 31- 4150 00 Storm DrRini4qo SySt Dov Chr-q (SSDC) 10-230 09 rRFD ...... 10-230 00 Washint1ton County I ire 01 (95%) 10-220 00 A,11,4rj./wodijewood 101111 if a0si 4 APPLICANT SIGNATURE y OaLp Received: Roceivud It : IP/ I OP