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11747 SW 129TH PLACE U•Ir,a•SLI LJ tJ LA 0 r Q e ry i • tl r, 4M. V 1 w Y. J. . .x L LL747 SW 129th Pl. wr CITY'OF TINA R® 7O F TWA RD 6ff COMMUNITY DEVELOPMENT DEPARTMENT 1002 + 13125 SW HWI Blvd. P-0-SM 23397,Tiglud-Z ; 7223 (603)639-417E KPL.DING PER111.11 I'll"RMI7 DUP90 PIER111IT 4. : BUP90-024-4 G,3':3._41'71. DA11'. ISSUED* 35X13/90 SITE A D)k ES 6. . . 1:747 SW :12911 PIL PARCIU: SUPDiviSION.I . . . » ZON I NG B I.A C K........._. .... --,._. . . . . . .. . .....1-01...... _..... -01 . . . . . . . . . . .I R F1 I E'S U E r:'LOOR EXTERIOR WALL CONSIRUCTION- LIJ)SE WORI.',. *Nr-W F ips,r.. . . . f N S., W TYPE OF USE. . . :0 TR SECOND. .. . .", S1 PROTECT TY[l�.7 OF CONST. »51..) THIRD. Sf 14: S.- E W. 0 1 0 Sf ROOF CONST: FTRE RL-.1-1: CCUPONCY GRP. --'R3 TA L----- 0 CC U P A N C Y L 0 0 1) BASE 11EIAT. r, Sf AREA SEP. R01'1:;'D-. STOR. St OCCU SEP. RATED: 5 HT. fit; GARAGE. . . " B S III T'?." IIEZZ":,.. R[ C4 D FT 1(1 C K S Rl' U U I R E 1)- FLOOR LOAD. . . . Sf L F.-'I., T ft RGH1 ft FIR SPKI-" SMOK DET. . ". DWEU. ING UNITS'. F RNT 30 ft P�I---A R ft FIR ALRII" i-INDIC -, ACC" 1.'i[-*.'.D R V G W 1-4 S IMP S%IRFACE". PRO CORR: PORKING" VALAH... 900 Renja-(+s.", '71 -feriee FEES N 14 1 S M I I C,1-4 E L L type aniat.tiit bY. date reCpt, PAYM 27. 20 JLH 08/13/90 I.:1'74'7 SW PRIIT D 1.Cl. 0 C4 Y 'l.'GARD OR 97223 PLCK 4. 10. 40 0: 644-8332 SE'C'T 0. 80 (1)WIN R/C 0 NTR A C"'0 R $ 27. P0 '110 1 AL Req OWNER RE(WIRED INSPECUONG This permit is issued subject to the relt-Asticr, contained in the Fina 1, Inspection ...... Tigard Municioal Code, Stat? of Ore. Spacial; s and All other applicable laws. PH work will be dere i- I ".L1 With approved plans. This Permit will @xPiTt if wOft'. is not started ___..•_,,.. within 180 days of issuance. or if work is susmnded for more ............. ....... than 180 days. ............ V:,erniittpe Lle d P Y ...................... ............... 639-4175 :ITY OF TIGiARD RECEIPT OFFAYMENT RECEIP-r r4o. :9(:).-2()3661 AMOUNT 2(-; NAME M.UrClHELL. DENNIS ("'ASH AMOUNI ! DDRES,.'- l :i *."4"* SW 129TH PL PAYMENT DATE 00- 1 SUDD I V I S,T ON 97227— FAJrePO!5E OF PAYMENT AMOUNT PATO PURPOSE OV F-Po'i'MENT AMOIANT PA ID BUILDING PEF*,"M OUFF90-0244 .16.0 PLAN CHECIV: FE I(1. 41) PUILEI PEP, f..). TOTAL. AMOUNT PA I D CITY OF TIGAIE I w'% 13+25 ►TauPLAN C1 B11PFI;TCATION Bo P.o.eoon n 23397 v� PIAN CIffJCK GC ,�` •-� Tigard Oreg97223 PERMrr _ COMMUNITY DEVELOPMENT DEPARTMENT (.503)639-4171 DATF. ISSUED JOB ADDRESS: ,� j t.v � Gr ` _ MX MAP/Inn 1 Sl 3 l�D !UDI SUB: Iln': LAND tZE: -- --— VAIIIATION �( OWNERM 1 SPE C-EAL NOTES NAME: _ ^fir n S /' / 1 REISSUE OF: Apps: a A^v LAST P,EI,S,SUE: �.. ROOD PLAIN/ SENSITIVE LAND: PHONE: APPROVALS RUMIRED CONIRAC OR P'LANUTNG: _— NAME: s w n I` _ ENGINEERING.: ADDRESS: FIRE DEPT -_- CMIER: PHONE: _ _ -TTEKSS SIRED BUIIDE SS WARD f: — LYP [AM: 1IST/SUBC10MPACIlOR : BUS '17X: ARCH/ENGINEER CALCULATIONS: NAME: TRUSS DL WE S: PHONE: _— sUEiam,Rw'PDR.s: PUM: _ --_ MMM: — PERMIT if ACX.T ' DESCRIMON AM 24T ANIO(= PD. BAL. DUE 10-437: 00 Building Permit Feces 10-431 00 Plumbing Pe.nw-t Fees - 10-431 Ol mechanical Permit Feces ----, 10-230 Ol State Building Tax (5%) Building --- -- Plumbing Mech 10-433 00 Plans Check Fee Building — Plumbing Medi 30-202 00 Sewer Connection _ -- 30-444 00 s(--wes inspection --_-- -- _ 51-448 00 Sl=eet S)-s;tem Dev Charge (SDC) 52-•449 00 Parks system Dev Charge (PDC) -- 31-450 00 Storm Drainage Syst Dev Choy (SSDC) - 10-2.30 06 Fire -_ -_--__ -- 717►T11L _ T�1'1'LI 4 TORE Received By: ___--- _--- Date Received: of/3587P.WPF KIMW-jLq—rLW--LW—AW%—ftwxWUNFA ID APPROVED FOR CONSTRUCTION ,614p CITY OF TIGARD PERMIT NO.25��- 4e�—'/JSITE ADDRESS 7 7 :±DATEg- A � s -----�-- - • 6 0 A ZA ,i C,Z A \\ I I X i Ll E i �'� h1 K,n a� �'�►S t h r,+'e J_ C. .nrr+ CP�cr 4 nA; Is r 0�� � S•�'�-1 n r1 F- CERTIFICATE CERTIFICATE OF OCCUPANCY COMMUNITY DEVELOPMENT U , CITYa oo�� PERMIT M. . . . . . a BOP$ X2234 PRIM. PERMIT 01. t 892L f4 13125 SW i-l�!1Rfwd. P.O.Box 23397,Tisarti3Orepon9722:i(603)839 41 75 DATE ISSUED: 04/05/90 SITE ADDRESS. . . a 11747 SW 12911 PL PARCEL: 1'31331)17 01000 SUBDIVISION. . . . $ ZONINui BLOCK. . . . . . . . . . $ LOT. . . . . . . . . . . . . 949 --------------------------- CLASS OF WORK. eNEW TYPE OF USE. . . sSF OCCUPANCY ORP. tR3 OCCUPANCY LOADi rVNON i' NOME:. . . F r.marlc�o re'- itsr•u• of 8810148 $..A0 ft)-0 2 'red line copies Owiie r a DUN MORI5SET1f PO BUX 195124 PORTLAND OR 97219-0000 Phone Mt 503•-244-2449 Contractors DON MORISSETTE BLDERS, INC. 0 0 BOX 19524 PORTLAND OR 97219 Phone N a 503-244-9314 Reg #. . t 355:3.3 0-cupanry of the above reterencvd building is hereby piven, arid rertifxe% the compliance with the �:)tatr Of Oregon Specialty Codes for the grot.ip, nc.*c't.tpanry, and -.tale tinde-r which the referenced permit wa % ittattea. FIRE DEPARTMENT l+N�ILDINO I BU11_.DI UFF AL.V POST IN CONSPICUOUS PLACE f ,^ INSPECTION NOTICE City of Tigard Building Department r� P.O. Box 23397 Tigard, Oregon 97223 J Phone: 639-4175 Type of Inspection Date Requested — `�i _ Time.-- Address ime._—Address !/ i �� � Permit Owner_ BuilderThe following Building Code deficiencies are required to be corrected: Presented to Approved Inspector ` �,� Disapproved Date CALL FOR RL.1r\-r,." CT10N ❑ YU ❑ NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection X Date Requested_ ti. –G 6 Time '1— A.M. P.M. Address 2 L 42 e7 f-%� Permit e// Owner _ Lot #_ BuilderThe following Building Code deficiencies are required to be corrected: Presented to 0`4pproved Inspector '�g22 [A Disapproved Date CALL FOR REINSPECTION ❑ YES ❑ NO INSPECTION NOTICE City Of (ig3rd Building Department P.O. b,)x 23397 Tigard, Orey,,in 97223 Phone: 639-41'5 Type of Inspection Date Requested.__.� Time— A.M.—P.M. Addr,ss Permit Owner Lot Builder The following Building Code deficiencies are required to be corrected: ------------- Presented to Approved Inspector W I— Disapproved T_ Dal _�=- f !2 CALL FOR REINSPECTION YES I I NO 0101Z�01_ - INSPECTION NOTICE City Of Tigard Building Department P.O. Box 23397 Tigard. Oregon 97223 Phone: 639-4175 � Type of Inspection Dar;, ►requested - 7 U Time _ A.M._ P.M. Address Permit Owner Lot # Builder The following Buiiding Code deficiencies are required to be corrected: u AW 'T C' tn�✓ � — Al Presented to F) Approved Inspector _ r I Disapproved Date ,�70 CALL FOR REINSPECTION C7 Y1112 ONO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection ' Date Requested Time _ A.M.._____P.M. Address Z/ '-/7 ��� `�.._ Permit #a1 Owner_ Lc• # Builder The following Building Code deficiencies are required to be corrected: Cn/ A14 _ 10 L$I- -r0 ;,a F-r=Fr— All„e D '�Pv,tz -ry -T-L/ __ �T �4Z e ►.l. _ �jj��a Chi-, S r�Au=_��:_✓�w� G� ���.y nc!-) C, P r'-Z Sl— 4tiy o 2"� Tlao� L:ICI 4.Z2_ lm i aly`ti�T' T�i>•L.NAC'c= _�_—. -�ynf�(t O��S.s.�- Presented to _.___—_ I Approved Inspector _._... approved Date Tr CALL FOR REINSPECTION 0 YE• 0 NO i IN;,PECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oreg^n 97223 Phone: 639-4175 Type of Ins-jectiun /ii'1— Date Requested— / Time_ A.M. P.M. Address _I1Z 17 ' '"' _ Permit Owner_ Lot Builder_ " The following Building Code deficiencies are required to Dro co;oected: i Presented to `� Approved Inspector ��✓_ L Disapproved Date CALL FOR REI ✓SPF,CTION ❑ YES 1 -1 NO i INSPECTION NOTICEA City of Tigard Building Department may_ P.O. Box 23397 Tigard, Oregon 97223 ILE Phone: 639-4175 Type of Inspection Date Requested Time A.VI. _—P.M. Address __ "-/ Pei mit ti ( Owner _ Lot Builder _-- i The following Building Code deficiencies are required to be corrected: ------- � AS, - Presented to A proved Inspector _ [_ Disapproved Ddte — CALL FOR REINSPRCTION C. YEt ❑ NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: E ,9-4175 Type of Inspection ` nate itequested L L -/,r � Time A.M. P.M. Addre a ��2 y�_ �a g v Permit #_ '1 Owner_._ _ _ Lot # Builder t� _ The following Building Code rl f*.-;iencies are required to be corrected: TT— r - I i w Presented to � ,Approved leis ctur } Pe - . -- - - --- Disapprovad Date ------ = � - - ----- CALL FOR REINSPEC77ON 0 YES [7 NO INSPECTION NOTICE !r City of Tigard Building Department P.0, Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Ujle Date Requested TI m P.M. Address --ZZ 7 ZZ 7 Permit *L70 Owner Lot Builder The following Building Code deficiencies are required to be corrected: Presented to _ Approved Inspector Disapproved Date CALL FOR REINSPECTION ri Y11 it NO C INSPECTION NOTICE City of Tigard Building Department c � P.O. Box 23397 Tigard, Oregon 97223 Phone 639-4175 Type cf Inspection _ �J 6V S � Bate Requested I— Time Address M. P.M. 1/ i�/7 / . �`� Permit # �� Owner_ Lot # :Z Builder Thp following Building Code deficiencies are required to be corrected: I Presented to Approved Inspector El Disapproved Date CALL FOR REINSPECTION ❑ YEa ONO CITY / OF TIGARD MIT NI. : PERMIT Q��t�n'sa�PE MIT NO. : BU892234 COMMUNITY DEVELOPMENT DEPARTMENT °R'O°" 13125 S.W.Hall Blvd..P.O.Box 23397.Tigard.Oregon 97229.(503)639-4175 E I9SIJED: 11/27/89 F10. 892234 JOB ADDRESS: 11747 SW 129TH PL TAX MAP/LOT ISI 33DD SLID: VILLAGE AT SUMMFRL.AKF 2 L1 :49 RK: LAND USE: R4.`;PD LOT SIZES VALUATION: $ 92,340 SFTBACKS FRONT: 20 REAR: 9 WORK CLASS: NEW DWFLI ,. IINITS: 1 LEFT: 7 RIGHT: 54 USE TYPEs SINGLE FAMILY NO.BILDROOMS: 3 EXT.WALL CONST: CONST.TYPEs VN NO,RATHS: 3 N: S: E: W: OCCUP.GRP. : R3 PROT.OPENINGS: OCCUP.LOAD N: S. E: W.- TOTAL sTOTAL AREA: 2109 NO.STORIES: 2 1ST: 1149 ROOF CONST: C FIRE RET? HEIGHT: 20 2ND: 960 AREA SEPAR? RATED: BASEMENT? 3RD: OCCUP.SE:PAR? RATED: MEZZANINE? BASEM'T FLOOR LOAD: 40 GARAGE: 440 FIRE SPRKLR? ALARM"? FLOW(GPM) DETECT, YES) ---- SAT- F-YT1E -6R6-- ..- -----+ (:P.-ACI6F663 PLAN CHECK BY: •rlt REMARKS: re-issue of 881048 REISSUE OF NO. 881048 $30 for 2 red line col)ie5 LAST REISSUE 892233 c� FEESs W MORISSETTE DON PERMIT $412.00 E Po BUX 19524 PLAN REVIEW $40.00 Portland or 91219 FIRE DEFT PHONE (503) 244-9314 STATE TAX $20.60 -- --- --- �.--- OTHER $30.00 0 DEVELOPMENT CHARGES: N MORISSETTE DON SDC(STORM) $25b.00 T DON MORISSETTE BUILDERS INC. SDC(STREFT) $600.00 A PO BOX 19524 PDC(N1 ) $050.0P O Portland or 97219 PREPAID ! $40.00) T O PHONE (:'03) 244-931.4 R REGISTRATION NO. 35533- TOTAL: $1,56i?.60 This permit is issued subject to the regulations contained in Title 14 RECEIPT FIO. /v/ of the TMC. State of Oregon Specialty Codes,toning regulations ------------ — --- (o and all other applicable codes and ordinances and it Is hereby REQUIRED INSPECTIONS agreed that the work will be done in accordance with the plans and FOOTING SEWER Specifications and in compliance with all applicable codes and FOUNDATION WALL RAIN DRAINS ordinances The issuance of this permit does riot waive restrir.tivn covenants Contractor and subcontractors shall have current city POST E BEAM WATER LINE business tax permits This permit will expire and become null and PLB.UNDERSLAB CITY APPRCH/SW void it work is not started within 180 days,or it work Is suspended or SLAB FINAL abandoned for a period of 180 days any time after work has PLB.TOPOUT commenced It:hail he the responsibility of the permittee to assure FRAMING all requ inspections are req0s d and approved FIREPLACE GAS LINE ' INSULATION Perm1lfee fs�ic GYP. BOARD B Issued By t TQR I1"15M CTION 631-417; SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE MORENA SEWER PERMIT ✓ / C17YOFTIFARD �j� PERMIT NO. : SE892461 crrfoansxtm 01lOON COMMUNIIIY DEVELOPMENT DEPARTMENT TE ISSUED: 11/27/89 13125 S.w Hall Blvd.,P.O.Box 23397.Tigard,Or-gon 97223.(503)639-4175 P I M.PMT.NO. 892234 JOB ADDRESS: 11747 SW 129TH PL USA NUMBER: 39126 TAX MAP/LOT 1S1 .33DD SUB: VILLAGE AT SUMMERLAKE 2 LT:49 BK: LAND USE: R4.5PD LOT SIZE: SECTION: 33 TWF': 1s RNG: 1w WORK CLASS: NEW USE TYPE: SINGLE FAMILY the applicant agrees to comply with all rules and requlations of the Unified Sewerage Agen,,y. The permit expires 1.20 days from the date issued. The total amount paid wi:l be forfeited if the permit expires. The Agency does not quar- antee t`1e accurate" of the location of the side sewer laterals. If the sewer is not looted at the measurement given, the installer shall prospect 3 feet in all directions from the distance qiven. If not so located. the installer shall purrhase a "Tap and Side Sewer" tlermat and the Agency will install a lateral. INSTALL. TYPE: BUILDING SEWER IMPERVIOUS AREA: FIXTURE UNITS: TENANT IMPROVEMENT: DWELLING UNITS: 1 NO. OF BLD03. : 1 W MORISSETTE DON OERMIT $35.00 N po BOX 19524 CONNECTION CHORGE f1,250.00 p portland or 97219 LINE TAP INSTALL. PHONE (503) 244-9314 OTHER C 0 MORISSETTE DON N DON MORISSETTE BUILDERS INC. R pa BOX 19524 C portland or 97219 T f PHONE (503) 244-9314 R REGISTRATION NO. 35533 TOTAL: 61.285.00 �U G L This rermit is issued subject to the regulations contained In Title 14 --------- --RECEIPT NO. Z --------- at the, TMC, State of Oregon Specialty Codes, toning regulations REOUIRE D INSPECTIONS and all other rpplicable codes and ordinances. and It Is hereby agreed that th, .-.irk still be done in accordance with the plans and ROUGH- IN 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 dayo,or if work is suspended or abandoned for n period of 180 days any time after work has ummenced It shall he the responsibility of the permittee to assure ill required Inspections are requested and approved : ilrne Signature Issued By ,)`i SRFLrTnW fiz9_4t75 —.. - -- 10� SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE CITY OF TIVA RD PLUMBING PERMIT �n�tf;'. PERMIT NO. : PL892459 cmoF rwslRn COMMUNITY DEVELOPMENT DEPARTMENT °°R°°« 13125 S.W.Hall Blvd.,P.O Box 23397,Tigard,Oregon 97223,(503)639.4175 E ISSUED: l i/27%8 .TOB ADDRESS: 11747 SW 129TH PL TAX MAR/LOT IS1 33DD SUB: VILLAGE AT SUMMERLAKE 2 1-1:49 BY,: LAND USE: R4.5PD LOT SIZE: ITEM: NO: N0: WOF'K CLASS: N-W WATER CLOSET 3 TF'AP USE IYPE:: SINGLE FAMILY URINAL B'<F'LOW F'RVNTR r:ONST.TYPE. VN LAVORATORY 3 TRAP PRIMER OCCUP.GRP. : R3 TUB SHOWER 2 GREASE TRAPS DISHWASHER 1 GARBAGE DISPOSAL. 1 NO.STORIF.5: 2 WASHING MACHINE 1 r DWELL.UNITS: 1 LAUNDRY TRAY BLDG.DRAIN (AIA FLOOR DRAIN SINK 1 SEWER (FT) WATER HEATER 1 STORM/RAIN (FT 1 I OTHER REMARKS: EELS: w MORISSETTE DON PERMIT $13?.56 N po BOX 19524 F portland or 97219 FIXTURES PHONE (503) 244-9314 STATE TAX $6.63 - -- ---- -.�•_------ OTHER C' 0 SHOEMAKER HAhOLD T SHOEMAKER'S PLUMB7' J R A po BOX 258 C eetacada or 9''823 ! PHONE (503) 638-7728 0 H REGISTRATION NO. 3922 TOTAL: $1,:114. I + �G'�1 (0 This permit Is Issued subject to the regulations contained in title 14 RFCEIPT NO. .2-- of the TMC. State of Oregon Specialty Codes, zoning regulations REQUIRED INSPECTIONS and all other applicable codes and ordinances, and It Is hereby agreed that the work will be done In accordance with the plans and PLB.UNDERSLAB specific, 'Ions and in compliance with all applicable codes and POST & BEAM ordinances The issuance of this permit does not waive restrictive WATER LINE covenants Contractor and subcontractors shall have current city PLB.TOPOUT business tax permits This permit will expire and become null and void it work is not started within 180 days,or If work Is suspended or RAIN DRAINS abandoned for a period of 180 days any time aftei work has FINAL commenced It shall be the responsibility of the permittee to assure ,n inquired is ctilons are. requested and approved AD � L Perrnitti S nature Issued By /`-" r -FOR_I1ISPEGLiC1d..b39-1175 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE CITY OF TIGrA RD MECHANICAL PERMIT FERMIT NO, : MF892460 i CITY OF T16ARD COMMUNITY DEVELOPMENT DEPARTMENT °0r°°" D E ISSUED: 11/27/89 13125 SM Hall Blvd.,P.O.Box 23397.Tigard,Oregon 97223,(503)639-4175 I M.PMT.N0. 892234 Y10R ADDRESS: 11747 SW 129TH PL 'TAX MAP/LOT ISI 33DD SUR: VILLAGE AT SUMMERL.AKE 2 LT:49 BK: LAND USE: R4.5PD LOT SIZE: ITEM: NO: N0: WORK CLASS: NEW FURNACE (100K ATR HANDLR (10 USE TYPE: SINGLE FAMILY FURNACE 100K+ 1 AIR HANDLR 10K CONST. TYRE: VN FLOOR FURNO(l:' EVAP.COOLER OCCUP.GRP. : R3 HEATER VENT FAN 4 VENT VENT.SYSTEM BLR/COMP (3HP HOOD 1 NO.STORIES: 2 BLR/COMP 3-15HP INCINERAIOR(DOM DWELL.UNITS: 1 BLR/COMP 15-30HP INCINERAIOR(COM FUEL TYPE GAS BLR/COMP 30-50HP REPAIR UNITS MAX, INPUT BL.R/COME' 50+HP OTHER 2 FIRE DMPRS? GAS PIPING OUTL.FTS l HIGH PRESS? LOW PRESS? REMARKS: FEES: W w MORISSETTE DON PERMIT $10.00 N po BOX 19524 PLAN REVIEW $11.25 portland or 97219 FIXTURES 4-35.00 PHONE (503) 244-9314 SPATE TAX, $2.25 ------- —___ ---- --- - --- OTHER C 0 N BEl_!_ HEA f ING INC. A 15550SE PIAllA AVE C CLACKAMAS OR 97015 T PHONE (503) 243-1184 R REGISTRATION NO. 44" TOTALft $58.50 RECEIPT NO. // 1 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 REQUIRED INSPECTIONS :agreed that the work will be done in accordance with the plans and GAS LINE specifications and In compliance with all applicable codes and POST d BEAM ndinances. The Issuance of this permit does not waive restrictive ROUGH-IN ovenants Contractor and subcontractors shall have current city FINAL husiness tax permits This permit will expire and become null and oid if work Is not started within 180 days,or if work is suspended or abandoned for a period of 180 days any time otter work has ommenced It shall be the responsibility of the pormittee to assure all required in tions are requested and approved Permittee Signatule Issued By 14,_ �, l- FOR T-49PCC4 "4-4175 SEPARATE PERMITS REQUIRED FCN WORK OTHER THAN DESCRIBED ABOVE I i I CITY Off' T16rA RD I/ � PLAN CIIECIC APPLICATION 4; cmr�w�..aa� PLAN a1ECK N — COMMUN[TY DEVELOPMENT OEPARTMENT:\ij!` PERI IIT « _— �]tss itv_�fJ cu.a_vo.aac mgr,lls.'QOc's�9rm.0031639-41rs� DATE ISSUED -- JOB ADDRESS: 1119 �Sj 120 PC iAX MRP/LOT A /5/-- 3390 LOT: LAND USE: SU13: Illl lva /CT S��mka ( A1 A L ----- — VALUATION: mac' 1 -- sPEciAt NOTES OWNER -mss C j",+1— C-n� S I►✓C - REISSUE OF: d T� U�I d q Sr LAST REISSUE: ADDRESS: U -- FLOOD PLAIN/ 0 _ - SENSITIVE LAND: _ PHONE: _ 2�f`t-`r 3r4 - - _ APPROVALS RE IRED PLANNING: _ CONTRACTOR ENGINEERING: NAME: -- _ FIRE OEPT ADDRESS: _-- OTHER: — --- ITEMS RE�l1IRE0 PHONE: -. LIST/SUBCONTRACTORS: " BUS TAX: _ - ARCH/ENGINEER n CALCULATIONS: NAME: C TV I � � �I��� TRUSS DETAILS:— -- ADDRESS: PARKING PLAN: -_ LANDSCAPE PLAN: -- OT11ER: _ PERMIT N ACCT N DESCRIPTION AMOUNT AMOUNT PD. GAL. DUE `L 10-432 00 Building Permit Fees 10--431 00 P1umbirv4 Permit Fees -- 10-331 01 Mechanical Permit- Fees 1.0-230 01 ;gate Building Tax (5X) y Building '-P•Go Plumbing — /.•G-3 floch 10-433 CK) Plans Check Fee. tau i I i ng3 Cvh=> Plumhi�x3 — — M�cli _1L• t�� ILSy / Z SU _ 30--7.07 00 Sewer Connection 3 30-444 00 Sewer Inspection 51-440 00 Street ,�yst-em Dcv Chargeu - 52-449 00 Parks System Dev Chartle (I'OC) 31-450 00 Storm Drainage Syst Dev (.Virg (SSUC) dr ----=�-'�- 10-230 09 TRFD -- 10-230 Ob Washington County Fire Ni __- 10-220 00 Amart/Wedgewood — i uTAL D ,13 1 T 3 REC It SfCNATURE v APPLICANT Received By: Date Received: _ cn/3507P/leP 4