7440 SW HUNZIKER ROAD-1 LTi
FILE NO. lib-'19
HUNZIKER ST. - 7440 STR. OPN. PERMIT
AFPI ICATION - "TREET IMPRIC VIEN1/EXCAVATIONC PY TO: ,
WHITE)-FILE
ORDINA,.,-F NO, 74-14 BLUEI-INSP.
INSTRUCTIONS ON ,EFIARATE SHEET -OTHER ACENr_v
I Y�wIPINK)III - A APAP L�IC�ANT
APPROVED � APPLICATION NO.:
NOT APPROVED CITY OF TIGARD, OREGON FEE AMT.: S 'f
El
FEE. PMT. U CITY HALL REC7T�[�!�.: __. A-4-1/4,
PENDING SECURI I'Y ❑ PUBLA;WORKS DEPARTMENT 13 _- DATEJ -7
PENDING AGENCY "OK" U Application and Progress Record MAINTENANCE BOND M
PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED I
ANNUAL_ ❑
PENDING VARIANCE O EXPIRATION D TE:
PERMIT NO, DATE ISSUED -_�__ - 7 _ . f3Y: .__...____. -
__.-_(1 ) P%EIICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL -L4-c,,4 L15' Cbp C � —
��.� V��� AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT _ •L.Lae Ley N>�YA eLS� ly(_- l,AA D &E f73 "A V 1)71X�i(AZy--___ '26-2'245
NAME ADDRESS CITY PHONE
C O N T R AC I OR kti LJ l /ZT DDRE Z_ L- r "'T L,/1 6. ` 4).Z-3 --- 6-4�a
NA ! CITY NONE
PLANS BY _bc � - __- �� _ �— ''`' ---- �
NAME ES■ CITE' -F-HONE
O L•
ESTIMATED IMPROVEMENT TOTAL VALUATIO ( COST): $
DOLLARS
(2) EXCAVATION DATA: FOR OFFICE It:_0 n{j7MIN.-
0.ozXs� = S _ � _
STREET _ _ — DESCRIPTION PROGRESS & INSPECTION STATUS_
NAME SURFACE CUT CUT CUT TMATERIAL INS'i ALLED ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DE?TH ITEM & QUANTITY
EEr W -- --
R TION
Q
c _6. U
ESTIMATED STREET OPENING DATE:_._.__ �- �, / C S
ESTIMATED STREET CLOSING DATE: _.. �"� E
_ _D
STREET -------•.�. _—
(3) SECURITY NO, ECURITY A T.: E_�_�____ CLOSED _
SURETY CO.: c. _ - c- x— _ FINAL
CERTIFIED CHIC �1 CASH ❑ BONrI Ll _- INSPEC.
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS/CONDITIONS
FEATURES: EXCAVATION LOCATION�ND EXTENT. i _--
I cl I I --------
II =FiA Ilu _—
3 b✓
1 1'1 1 I I
1 1 I I
1
(5) NOTE THE CITY OF TIrARD DOES NOT, HEREBY, GRANT PEPMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON.
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AtiAINS7IN.IURY OR DA GE)IY►+ICH MAY RESULT FROM APPLICANTS ACTIONS.
APPLICANTS SIGNATURE