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CITY OF TIGARD Plumbing Permit
Building Department No. 3 ?
Residential commercial
New Installation Replace Addition E-1 Alteration Lj
DRte
Liconsed
FI". -riber Owner
Address 4_rE'Le�k,-)AA,. 51
;_,(&) -- Job Address U,1",35 0 Zz ly
Phone -3 70
Applicant
CITY BI'51NESS LICENSE PEOUIRED FOR At,L CONTRACTORS AND SUB-CONTRACTORS
ITEM NO. FEE TOTAL IML NO. FEE TOTAL
Fixtures-Traps 7.50 —.-Sewer:First'10oft,'I -k'- 30.00
Dishwasher 7,50 Each Add
Garbage Disposal Ejector Purrip 7.50
Water Heater 7.50 Water�First 100 ft� a —
20.00
Backflow Preventer 7.50 Ebr,,hAdd1t.200f',. —15.00
Storm&Rain Drain:First 100 ft. A 30.00
Each Addit.200 ft. 11 15.00
Mobile Home Sp 25.On Space
Other(Specify):_ Rain Drain-Single Fam.Dwellingt
L1 f, 1500
PERMIT FEE GomrT
Issued By:
STATE
neceipi No. Apphcanf____ ae_L
TOTAL F,,)r Pluribing Inspection Phone 639-4171 Signature