11205 SW MORGEN COURT-1 FILE NO.
MORGAN CT. - 11205 STR. OPN. PERMIT
APPLICATION — STREET IMPHC 'MENT/EXCAVATION COPY TO:
WHITE)-FILE
ORDINH..CE NO. 74-14 BLUEI•INSP.
(INSTRUCTIONS ON SEPARATE SHEET) (FELLOW) •OTHER AGENCY
`-<IF PIK) APPLICANT
APPROVED APPLICATION NO.: I 4`� _ _
NOT APPROVED �O CITY OF TIGARU, OREGON 11
PENDING FEE, PMT. 0 CITY HALL. RECEIPT N .: _
PENDING SECURITY O PUBLICWORKS DEPARTMENT BY _.-- DATE
PENDING AGENCY ••O ^ 0 Application and Progms Record - — — — — — —
PENDIN; AS REgU11iEU
INFORMATION O FOR STREET IMPROVEMENT/EXCAVATION MAYNT MANCE BONp/1�1�'„_
AANUAL (]
PENDING VARIANCE ❑ _ EXPIRATION
DAT0
747
_
PERMITNO. ! 1
BY::
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR Al".v INSTALL
`�� AS DESCRIBED HEREIN. IN FULL ACCORDANCE WITH CIT REQUIREMENTS.
APPLICANT __- G ���C \• --_ , ` �•at ,' ... 1 °1'7l > xZ
_ _ ADD . _____ yj _ IVr L'.:.«`r:.♦ ', yam_ 7(I
A �
CONTRACTOR CITY' -- PHON�r'—'—
_ 1 '!rs«I 1r'\-��
NAME T ADDRJ�S CITY p-HuE
PLANS BY _ _ c• •� �
NAME AD f ITY HpNE
ESTIMATED IMPROVEMF_NT TOTAL VALUATION ( COST): S
DOLLARS
(2) EXCAVATION DATA: 0.02 xFOR iCE uz (46 IN.
STREET _ DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT rCUT CUT MATERIAL INSTALLED ITEM DATE` REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM d QUANTITY
STREET _
l, \ INSP -
R TION
4
Q
U
ESTIMATED STREET OPENING DATE: L" ES
ESTIMATED STREET CLOSING DATE: •} / �. / T
E
(3) SECURITY NO. .�..,, $'GECUr�ITY AMT.: REET
_ _ CLOSED
SURETY CO.: x � �-y 4� � �� FINAL
RTIFIE0 CHECK ,
p CASH O EONfI INSPEC.
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS/CONDITIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT.
LJSk
lit
441
I ile I
t�
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r 1 ( I
(5) NOTE THE CITY OF TIGARD DOES NOT, HERrBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT OF WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON,
THE APPLICANTAGREES TO DEPOSIT THE REQUIRED SECURITIES. TO COMPLY WITH ALL PERTINENT I.AWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
t MPI.OYEES AGAINST ANY INJLIPY OR DA41AGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
APPLICANTS SIGNATURE
DATE._
CITY OF TIGARD—12420 S.R CE F TIGAR[1,OREGON 97223
c
AMOUNT:
CA-S--H—'
NA A CK
ADDRESS: M.O.
1
I OF 4MOUNT
FOR: CCT• N PERMITS SURCHA1tOE
e -
SEWER BILLINGS 40-364
BUSINESS LICENSE 05-331 —
c -
PLUMBING PERMIT
OKI•332 ._._-- -------"-
MECHANICAL PERMIT 05-332 — --- -- —
— ---�-----
BUILDING PERMIT 05-333 �—
SEWrP CONNECTION 40-363
SEWER INSPECTION 40-365
SYSTEM DEV.CHARGE 25-366
FARK DEV CHARGE #1 30-367
PARK DEV. CHARGE *2 30-368 -.--- �- - -
ZONING ADJUSTMENTS 05-362 _^--
TOTALS -- �`—
RECEIVED BY:
PERMIT NUMBS s SSIONEO: Amount _ _Number_ AmouM_
Number AmountNUm"!
S $ _
8521