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CITY OF TIGARD (,LkFIFICWL OF
COMMUNITY DEVELOPMENT DEPARTMENT OCCUPANCY
13125 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)639,4171 PERMIT ##. . . . . . . . MS7 r93--0451:i
I DATE ISSLIr-.*D- 027/18/94
PARCEL: 11,31,34AC-04100
SITC ADDRESS. . . : 10863 SW 111TI-4 AVE
SUBDIVISION. . . . : HART"..-'' LANDING ZONINGaR--4. 5 PD
BLOCK. . . . . . . . . . > LOT. . . . . . . . . . . . . :01E
CLASS OF' W(JRV,. :(14EW
TYPE OF USE. . . :SF
OCCUPAN.LV C-,,PP. :R3
OCCUPANCY IOAD:230 4
TENANI NAME- -
Remarks : PATH I
RENAISSANCE DEVELOPMENT CVORP
Phone #i
contractorr
RE.NAISGANCE DEVELOPMENT
1672 SW WILLAMETTE F'ALLG DR
WE LANN OR 97068
Phone #; 557-8000
Peg 0. . c 413955
Occ.,i-ipancy of the above ref erpitced bui Id i fig j. s he, i,by L4 i vfm, and cert i f i
the (..,ompliance with 4.he State Of Oregon Opecialty Codes For the group,
orcupancy, incl use under which �hp referenced per-mit was issued.
_..._.F RE DEPARTMENT BUILDING IN, PEG-7-9k
(3 OFFICIAL
POST JN CONSPICUOUS PLACE
1110
j!',_AECT�ON NOTJCE
City of Tigard Bal]diag Department
13125 811 Ball Blvd. Tigard, Oregon 97223 CW
Inspection Line (Rec-O-Phona)t 639-4175 Business Phone. 39-4171
Inspections—. _, —
Footing Plbg. Underelab Mech. Po.igh-in Appr/Sdw1k
Found. Plbq. Top Out Goo Lina I//NAA�L��
Yost/Beam Struct. San. Sewer Framing ("-D
Poet/Boam Mach. Rain Drain Insulation lamb
Plbg. Unrerflror Nater Lina Gyp. Rd. G�
i
Date Req-astsds ��V `7 1 Times AM _i1 PM
Addreass�� S(�✓ 1��yr Permit f,MST
Builders PQ 0 Air �- —
TBE FOLI.OiIIIEC{ CORRB—
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Inspectors Oates2_
APppOVEO DISAPPROVED nePI?OVND SUBSRCT TO ABOVE
Call For Reinsp.
LP7�P`�C'TION NOTICE
city or Tigard Building Depart-sent \
13125 a- Ball Blvd. Tigard, Oregon 97223
Inspection Line (Sac-O-Phone): 639-4175 Business Phone: 639-4171
inapectiont,
Footing Plbg. Underslab Mach. Rough-in Apps/Sdwlk
Found. Plbg. Top Out Can Line FINALt
Post/Beam Struct. Ran. Bawer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbq. Underfloor Nater LUne { gyp. 8d. � � -Mach.
Date Aequeeted:`_+�. r r ✓ Times �t AN _PN
Address:- [1l` o3 p.it
Buildart_ � ��GL��7 .•a✓ �'?Gl �� Y 1/2-14- -7LI(f �--
TNI FOL.I.OWING CORRECTIONS ARE REQUIRIDt
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CA
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Inepectart Date:
_" DISAPPROVED APP)IOVRn BUBJICT TO ABOVE
mall For Reinap.
jMSPZ_rCTIOK NOTICE
City of Tigard Building Department
13125 ON Ball Bled. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)s 639-4175 Busines3 Phone: 639-4171
Inspections
Footing Plbg. Underslab Hach. Rough-in ApFr/Sdwlk
Found. Plbq. Top Out Gas Line FINAL-
Post/Beam Struct. San. Sewee Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Une X Opp. Bd. -Koch.
Date Requestedps/ -J AK
nPM
Addren :_Il /� 1P /// C
_ Permit Is_`
Builder: �f-`-
TRE FOLLOWING CORRECTIOMS ARE REQUIR"D:
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inspectors w r Dates�1
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APPROVED
APPROVED DISAPPROVE:; APPROVED SUBJECT TO ABOVE
I Call For Reinsp.
Ty�NSPBC'' 0
J4 N_�CE
Cite or Tigard Building Depertstoat /
13123 SW Rall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 679-4175 Buninese Phon
Inspectiont
Tooting Plbg. Undersl.ab Mach. Rough-in App-/SdwlY
Found. Plbg. Top Out Gas Line PINALt
Poet/Beam Struct, Sats. Sower Framing -Bldg.
Pont/Beam Mach. Rain Drnin �In9ulaLto -Plumb.
Pliv. Underfloor Water Line Gyp. Bd. _Koch.
L _
Data Requestsde—Z �� `^ Tuant _�.AK PH
Address /r ) �1�� Permit #es y 3
Builder: _4 SC; /n.i
THE FOLLOWING CORRECTIONS ART, REQ' .RED%**
Inspectors DateY
1CPPROVRD _ DISAPPROVED APPROVED SUBJRCT TO ABOVE
UVJ
__Call For Reinep.
www
IMM2TION NOTICE
C.tr '.t Tigard Building Department
131"- dW Hall Blvd. Tigard, Oregon 97223
"a,.e (Rec-O-Phone)s 639•-4175 Businerc rnone: 639-4171
Inspection:
looting Plbg. Undcrulab Rech. Ao� Appr/Sdwlk
Gas Lins� FINAL:
Post/Beam Struct. San. Sewer (Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plljy. Underfloor pater Line Gyp. Bd. -Hoch.
Date Requested= 1� ` �" limes AN PH
Address: Permit
Builda.:
THE FOLLOWING CORRECTIOMS ARE REQUIRED:
V1
C�
41
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Inspector: -- Date:.1,2
PROVSfl DISAP?ROVED APPROVED SUBJECT TO ABOVE
Call For Reinap.
INSPECTION NOTICE
City of Tigard Building Deparlmen
13125 SK Hall Blvd. Tigard, Oregon
Inspection Line (Rec-O-Phone): 639-417 Buain no: 639-4171
Inapection:__
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line ?INAL:
P LfBeFL'StrQC�t:--- gan. Sewer Framing -Bldg.
�L(�aam Meeh. Rain Drain insulation -Plumb.
-•
ba_Underfloor Mater Line Gyp. Bd. -Hoch.
Date Requented: lC Timet AM PM
Address /C �(� y [ Permit'F� v
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
v
LLl - - - -
Inspector:— _ Dare:
Armwgn DISAPPROVED APPROVED SUBJECT TO ABOVE
Call Far Reinap.
INSPECTION NOTICE /
City of Tigard Building uepartaent
18125 ON Ball Blvd. xigard, oregass 97 ,/
Inspection Line (Rec-O-Phone)s 639-4175 Busin®ss Ph es 639-4171
Inspections
Footing Plbg. Underalah Mach. Rough-in Appr/Sdwlk
Found, lbg. Top Out�) Gas Line rrNALt
Post/Beam Struct. San. Sewer framing -Bldg.
Post/Beam McC-1. Rain Drain Insulation -Plumb.
Plbg. UnderLlo3r Nater Line Gyp. Bd. r-Koch.
Date requested 1zcst �, �_��_ TimeA14 �PH
Addreses� — 4(,� % ermit r
Buildera lo 66
THE FOLLOWING OORREC:TIONS ARE REQUIRED:
In
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CAO
CD
LU ----
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Inspector: �. Date Z _�
PSP ROVED nISAPPRCfVED _--_ APPROVED SUBJECT To ABOVE
___Call For Rainep.
IT . ?CTION NOTICE
City of Tigard Building Department
13125 SW 8111 Blvi. Tigard, Oregon 97223
Inspectior Line (Rec-O-Phone): 639-4175 Business Phone- 639-4171
Inspection:_
Footing Plbg. Undereleb Mech. Rough-in Appr/Sdwlk
Found. Pl.bg. Top Out Gee Line FINAL:
Poo*!Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. C Ral.n Drain Insulation -Plumb.
Plbg. Underfloor Waters Line Gyp.
Gyp. Bd. -Mech.
�Duro Requeated: /Q//U /!/ ? --Ti—:
Address:1�(p��3 ✓`�. ���r� Permit
Builders el
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector --- ____—�—_--- -—� Datel�
APPROVED DISAPPROVED APPROVED SUBJECT TO 118-" B
Cell For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 SM Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection: _—
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. hop wt Gns Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Date Requested:i/Ve-��'? Time: -__�AM PM
L_f
Address: Z4 �s(.� _ —
2 i Permit t _
Builder: � Le
THE FOLLOWING coRRECTIONS ARE REQUIRED:
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Inspector: jt
Dae:
--— y !/
PPROVED UISRPPROVED - APPRM-8n SUB.IRCT TO ABOVR
Call For Reinsp.
INSPECTION NOTICE
City rf Tigard Bail-ding Department _
13125 GH Hall Blvd. Tigard, Oregon 97223 "�-
Inspection Line (Rec--O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Pibg. Unde:alab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gns Line FINAL:
{ an. sewer Framing -Bldg.
4ottr($eam H@ch. Rain Drain Insulation -Plumb.
P:�bg. Underfloor w70/7
Gyp. Bd. -Hoch.
DateRequested _zv Time: AH PH
Address: 1OP `�3@rmit #i- _
Builder.:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
C / rri.t/'
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�Inspectors, _ _ ` Data://�
AF D DISAPPROVED APPROVED SVWRCT TO ABOVE
Call For Reinsp.
PLUMBING PERMIT
CITY OF TIGARD Pl-RMIT #. . . . . . . : M6793-111459
777
COMMUNITY DEVELOPMENT DEPARTMENT DOTE ISSL.'r-'D- 09..,'06/93
13125 SW Hall Blvd.Tigard,Oregon 97223d6199 (502)639-4171
PORCEL. IS134AC.--.04100
51TE—n"DI)RESS. . . : 10863 SW 111TI-A AVE
SUBDIVISION. . . . . HART' :• LANDING ZONING: R-4. 9 PID
BLOCK. . . . . . . » LOT. . 0 1 vP.
CLASS OF WORK. :NEW GARBAGE DISP65ALG. . : 1
'�YPIE OF US�':. . . -SF WASHING MACH. . . . . . . . I BACKFLOW PRE'VNI'PS. V,
OU'UPANCY GRP. -R,3 f"LOOR DRAINS. . . „ . . . .0 'TRAPS. . . . . . . . . . . . . . :0
STORIES. . . . . . . . :2 Wf--IT*ER HEATERS. . . . .. . : 1 CATCH BASINS. .. . . . . . :0
F J.XTUREG--- LAUNDRY TROYS. . . . . . : 1 SF RAIN DRAINS. . . . . : 1
SINKS. . . . . . . . . . : 1 GREASE TRAPS. . . . . . . Q.,
LAVATORIE,'.;. . . . . :4 OTHER r- IXTUREG. . . . . :0
TUB/SHOWERS. . . . - Sf.*.:WER LINE (ft ) . . . :121
WATER CLOS STS. . :3 WATr`R LINE ( ft ) . . . . - 100
DISHWASHERS. . . . -, I RAIN DRAIN ( ft ) . . . . :0
OWNER:
:W.-NAISGANCE DEVELGPMENT CVORP T I F $ 1520. 00 JH 09/06/93
BPRT $ 468. 00 JV1 09/06/93
BPLC $ 40. 00 JLIA 08/1 0/93 93--243---
S 7 B5PC I, c.:',x. 40 JF1 09/1716/93
j BP'LC $ 15. 00 31-1 0(3/06 P)3
SSDC $ 260. 110 JH 09/06/93
r-"11..1m1.-)inu Cant i.,actor: PARK $ 500. 00 .IH 09/06/93
MPRT $ +5. VILA JH 09/06/93
MPLI." $ 11. 25 J H 09/06/9;x.
--aye
11SPC $ 2. 25 J 1-4 09/06/9_ti
State: PPRT 1.55. 00 JH 09/06/9:
Z i P C 7& S-S(0 S P'51--C $ 7. 75 JH 09/06/9-
&)
Req
-
R E 2 U I RFI) INSI-'EC TION"
This permit is issued subject to the r-eg
i.ilationt, contained in the Tigar,d Municipal Fo o t f 0 4-1 T)Cl Ins( Pain dt-air: Insp
Code, 5tatc� of Or-P. Specialty Codes. And all Plost/Beam Gtiuct Wate- Line Insp
other- applicable laws. All work will be done Flost/Bearu Mpchan Appt-,,Icj:dwlk Insp
in accovdanco with atipt-oved plans., This Plm'/undilab Insp Mechanical Final
peir,mit will ta)(pive if work is ri.c-t starte.d PIL.Mv" 'irldet-floor Plumb FJnaI
within ) 816 day,> of issuance, or, if woi k is MechznicAl. Insp Building FITIAI
suv;rpeodecl for mo than J60 days. Plumb Top Out Et,osion Control
Fr-ArrinU Insp Cr-,Awl Drain
Fit— place Insp
Gas Line Intp
Insifl.ation Insp
Gyp Board Trisp
F)10:hr))-,izPd P! mtti :m toi- 13 i g n at 'At'l?
Call for, inspection 639--4175
("onti'actat, N a t e S
MASTER PERMIT
CITY OF TIGARD PERMIT #. . . . . . . . MST0
COMMUNITY DEVELOPMENT DEPARTMENT DOTE ISSUED: 09/06/93
13125 SW Hioll Blvd.Tigard,Oregon 97223.8199 (503)839-4171
i'ARCEL. 15134AC•-0R'4100
_;11_E ADDRESS. . . 1.086-, :�W IIITH AVC
SUBDIVISION. . . . : HART" S LANDING ZONING: R-4. 5 f='D
BLOCI.. . . . . . . . . . . LOT. . . . . . . . . . . :012'
BUILDING _._._....
RE ISSUE:MST93•--02:1'2*8 DWELLING UNITS: 1 BfISCMENT. . . . . . . . .2, s f
CLASS OF' WORK. :NEW BEDRMS:3 BATHS:3 GARAGE. . . . . . . . . . :492 sf
TYF'E OF USE. . . :SF F L._OOR AFREAS-•••---------.----_ [REQUIRED Sf TBfaCI;S-•--•.._...-_._.---.._._
TYF E OF CONST. :5N F:•I RST. . . . . 1.095 s f LEFT, . :5 ft RIGHT. -.5 f t
OCCUPANCY GRE'. - R3 SE=COND. . . : 1 184 sf F FRO 1\1 T. :C20 ft REAFR. . :40 ft
STORIES. . . . . . . :2 THIRD. . . . :0 s f REQU i
11E I GHT. . . . .. . . . :30 ft TOTAL --- - -:2279 S f SMOKE DETECTORS. :Y
FLOOR LOAD. . . . :40 psf VALUE. . . . . $ : 113690 F'ARKINU SPACES. . : 1
Remarks : PATH I
PLUMBING
SINKS. , . ., . .. . . . . : 1. FLOOR DRAINS. . . . :0 BACKF'LCW f'REVN•TF15. . :0
LAVATORIES. . . . . ...4 WATEK HEATERS;. . . : 1 TRAPF3. . . . . . . . . . . . . . :0
i UB/SHOWERS. . . . :3 LAUNDRY TRAYS. . . : 1 CA'T'CH RACINS. . . . . . . :0
WATER CLOSETS. :3 GLWER LINE (ft ) . :0 GREASE TRW:S. . . . . . . .0
D I SHWA SF;ERS. . . : 1. W A T E R L..IN C' (f't ) . : 100 OTHER F I XTI RES. . . . . :0
GARBAGE DISE'. . . : 1 RAIN DRAIN (ft ) . :0
WAST I I NG MACE i. . . : 1 Sr" RA I N DRA I ISIS. . : 1
MECHANICAL -_...,___._ _.._._..______._.__._._.____....__..._._._......__._.. FEES
FUEL TYE'E5 _.._.__._.-____._._..-• UNIT HTRS. . :0 type amuijrit y date recpt
/GAS/ / / VrNTS . . . . . :0 1IF- 4 1520. 00 JH 09/06/93 -
MAX INPUT:O BTU VENT F-ANS. . :4 11F'RT $ 468. 00 JH 0".)/06/93 --
FURN ( 100K . . :0 HOODS. . . . . . : 1 BF'LC 'l: 40. 00 JLH 08/20/93 93-24?
r""URIti ) =1001-1, . . . 1 WOODSTOVES. :0 P5P'C $ L3. 40 JH 09/06/93
FLO(-''R F'URN. . . . :0 CLO DRYERS. : 1 BF'LC $ 1"x. 00 JH 09/06/93
MOIL./CMT"' ( 31TPz0 071-IE:R UNITS: 1 53DC $ 2_'80. 00 J11 09/13:,/93
GAS OUTLET : i PARK fi> 500. 00 JH 09/06/'.13 -
Own�r: _.._.. _.__._..__........ . ............._.._..._.._.___......_.____....._._.._._._.._._Mf='RT $ 45. 00 JF-; OW06/93 -
RENAISSANCE DEVELOPMENT4CVRPI, MF'LC $ 11. 25 JFi 03/06/93 -
MSPC $ 2. 2`, JH 09/06/93 -
/ ^E'RT A 155. 00 JH 09/46/93 -
(f P 17,C $ 7. 75 JF-1 09/0 6/9,3 -
1='1-ione It:
Cunt" art or: ._._ `_"-___._
RENAISSANCE;SANCF C►E I�'LOf='M I f
1 ,',7,"' SW WILL.A E:TTE FALLS JR
�,L',T LINN 013 97068
Phone #: 557-8004'
Reg #. . : 49955
3067. 65 TOTAL
This permit is issued select to the regulations contained in the - ----- REG?UIRED INSPECTIONS -- -
Tigard Municipal Code, Star of Orr.. Specialty Codes and all other Foot/foi_tnd ITtsp Fireplace Insp
applicable laws. All work will be done in accci 'unce Nithproved Pn st/Lae a m St rl.tct Gas Line Insp
pians. This permit will eypire if work is not started __hfa 188 Post/Beam Irlech,an Tnsl�latiun Insp
days of issuance, or if work i . suspended for re than id days. P11 m/1-in d s l a b Insp Gyp Board Insp
PI_M 'Underfloor Rain drain Intil-i
,,,mittee 5ignati-tre : �._ 2.. Mecriaric 1 Insp Water Line Insp
7m To Ol.tt Aopr/Sdwlk Insp
1 �supd lx., (,_ /all
framingLisp Mechanir.a1 1`-incl
for inspection 539-•41.75
SEWER CONNECTION
CITY OF TIGARD PERMIT #PERM'IT` : SWR93--0393
COMMUNITY DEVELOPMENT DEP-AR7iMEN7 DATE ISSUED: 09/06/93
13125 S%v Hall Blvd.Tigard,Oregon 97223.8199 (503)839-4',1
PARCEL: 1S134AC•-04100
TL ADDRE:(SS. . . : 10663 SW 1 1 1 TH AVC:
.,..JBDIVISION. . . . : HART' S LANDING ZONING: R 0 PI)
BLOCK. . . . . . . . . . : L.O'T. . . . . . . . . . . . . :01 _
TENnNT NAME:.:.
J90 NO. . . . . . . .. . . . FIXTURE UNITS. . .
CLASS OF WORK. :NEW DWELL I NG UN I TS. . ; I
TYPE OF USE. . . . . :SF NO. OF BUILD;NGS: 1
JNSTALL 'TYPE. . . . ;LAl_I..1WI IMIDERV SURFACC. . ; :sf
1`.emrrr-ks : PATH I
r--�-- FEES
:IU0ISSANCE DCIV OPMCNT CVORP type amol_rnt by (Jate r^er,jt
PRMT 9 2200. 00 JH 09/06/93 .-.
INS� 7. 35. 00 .JII 01)/0-i9.3
iNTRAC'TOR NO ON FILE
1 1-lnne i#e $ 223'x,. 00 TOTAL
Reg
_._ REOU I RED I IVSPECT I ONG --------
This Applicant agrees to comply with all the rules and regulations Sewer Inspect ion
o` the Unified Sewage Agency. The permit expires 180 days from
the date issued. The total amount paid will be forfeited if the
permit expires. The Agency does not guarantee the accuracy of t� _
side sewer laterals. if the sewer is not located at the measurement
given, the installer shall prospect 3 feet in all directi from
the distance given. If not so located, the staller . a/ purchase
"Tap and Side Sewer" permit and the A cy will i st lateral.
-,i-,v,mittpe
F_ Call for, irls>pectiorn — 639•-4175
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CITY OF TIGARD — RECEIPT OF PAYMENT RECEIPT NO. iSi3-244031
CHECK AMOUNT a 5262. 65
1,,InME a RENAISSANCE DEVELOPMENT CASH AMOUNT a 0. 00
ADI)RESS a PAYMENT DATE a 09/09/93
SUBDIVISION
PlJRPO(-iE OF PAYMENT AMOUNT PAIL) PURPOSE OF PAYMENT AMOUNT PAID
BUILDING PERM 468. 00 PLUMBING PERM 155. 00
M['.fHANICAL PE 45. 00 ST. BUILD PER 33. 40
P1-AN CHECK FE 26. 25 SEWER USA 2200. 00
SEWER INSPECT 35. 00 PARKS SDC :500. 00
STORM DRAIN SDC atlo. 00 RESIDENTIAL TRAFFIC FEES 1410. 00
MASS TRANSIT TIF FEES 110. 00
LOT 12 HARTS LANDING
10863 SW 111TH AVF
TOTAL AMOUNT PAID 5262. 65
13125 SW HallWvd.
CITY PLNCK/RECT #
OF Z IGARD PERMIT # �I5��3-Oif-5
c OINIMUN11TDLVELOPMENT'DEPARTMENT TBra^�UfOBon9n13
(503)63"171 DATE ISSUED
JOB ADDRESS: j[-'0 (P CD l r/` �� 1 TAX MAP/LOT 151 3YkC
SUB: HARTS LANDING LOT: I� LAND USE: �I-� C P J•�
VALUATION:
OWNER SPECIAL NOTES
NAME: RENAISSANCE DEVELOPMENT CORP _ REISSUE OF: .
ADDRESS: 1672 SW WILLAMETTE FALLS DRIVE LAST REISSUE:
WEST LINN, OREGON 97068 FLOOD PLAIN/
PHONE: (503) 557-8000 SENSITIVE LAND:
CON'WCTOR APPROVALS REQUIRED 5��69Z-0O�
NAME: RENAISSANCE DEVELOPMENT CORP. PLANNING:
ADDRESS: 1572 SW WILLAMETTE FAILS DRIVE ENGINEERING:
WEST LINN, OREGON 97068 FIRE DEPT:
(503) 557-8000 OTHER: '11F
CONTR. BOARD #: _ 49855 _ EXP DATE: 571�1?4
ITEMS RE U� IRED
SURCONfRACTORS: PLUMB: EAGLE PLUMBING LIST/SUBCONTRACTORS:
MECH: TRI—COUNTY TEMP CONTRm. BUS .AX:
ARCH�FNGINEER CALCULATIONS:
NAME: ALAN MASCORD TRUSS DETAILS:
ADDRESS: 1515 NW 23RD OTHER:
PORTLAND, OREGON 97210
r
PHONE: _ 225-9161
J
PROPOSED BLDG. USE: SFR _
F� COMMENTS: f e F Y
�A>� FFATaI rz Es o=A/ M�d��� 0 :o T 1/ AiSEA f r�Of Aft (e4,v> RNo Si re e6411
ZP7' // /5 YNE. !.or 11"l 1f1)/A7fC
A PL T •FrtGNATURE
Received By:,_ _ Date Received:
PERMIT B ACCT # DESCRIPTIDN AMOUNT AMOUNT PD. BAL. DUE
o 10-432 00 Building Permit Fees `"
10-431 00 Plumbing Permit Fees
~ 10-431 01 Mechanical Permit Fees '��
10-230 01 State Building Tax (5%) 3-3.q 0 — i L' L
Building
Plumbing 7• ?� ,!
Mechanical
I
10-433 00 Plans Check Fee
Building D
Plumbing /
Mechanical �� 2
10-230 06 Fire
t wR�3 03 -J 30-202 00 Sewer Connection .2?
30-444 00 Sewer Inspection
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
25-448-05 Mass Transit TIF Fees _��� // U
52-449 00 Parks System Dev Charge (POC)
_iJG0
31-450 00 Storm Drainage Syst Oev Chrg
(SSDC)
24-445-01 Water Quality (fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of)
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TOTAL 5J0Z,Gs 0. s� 5.L42, �S
nm/3587P.WPF
w • �