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CITY OF T I %WFN
COMMUNITY DEVELOPMENT DEPARTMENT
13126 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)639-4171 PLUI+IP I NC PERMIT
PERMIT #. . . . . , . : PLM94-00 9
6C39-4173. DATE ISSUED: 04/20/94
PARCEL: IGI34CA—•0061
S TL ADDRESS. . . : 12025, SW IhANZANITA 91"
SUBDIVISION. . . . : PANORAMA ZONING: R--4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . : 11
CLASS Or WORK. . :NEW GARBAGE DISPOSALS. - 11OB I L_E HOIrIE SPACES.
TYPE OF USE. . . . :SF WASHING MACH. . . . . . . : BACKFLOW PREVNTRS. . : 1
OCCUPANCY LRP. . : Rd, I-LOOP DRAI.NS. . , . . . . . -f RAPS. . . . . . . . . . . . . . .
STORIES. . . . . . . . : WATER HEATERS. . . . . . : CATCH BASINS. . . . . . . :
F I X1 U12ES- —--__.._._...___. .__-- LAUNDRY 1•HAYS. . . . . ,• : SF RA 1 N DRAINS. . . . . :
SINKS. . . . . . . . . . . URINALS. . . . . . . . . . . . . UREASE TRAPS. . . . . . . .
LAVATORIES. . . . . : OTHER FIXTURES. . . . ,. :
TUB/SHOWERS. . . . : SEWER LINE ( ft ) . . . . :
WATER CLOSETS. . : WATER LINE (f t ) . . . . :
DISHWASHE:RS. . . . : RAIN DRAIN (ft ) . . . . :
Remarks : INSTALLING IAL ,: FLOW f='RE:VENTION DEVICE
Owner.: ___._._______________._..._...____. ...._ _..._._..._._._.____......._...___.____ ...____.___ FEES
RICHARD CLARK type amo+_rr1t by date r~ecpt
1"=_1025 SW Mf!NZANITA CT PRI11 $ 17. 50 BLT 04/c:0/94
5Pl'T $ 0. 87 BLT 0-4/20/94
TIGARD 013 97223
Ph on a ##: 5916-2 622
1
C;ontr~ar_.tor~:
OWNER
i
f`hurie it : t 18. 37 TOTAL
N 4. . :
REOU I RET) INSPECTIONS
_........__ _.—.-.-_
This permit is issued subject to the regulations contained in fine Top--or_rt Insp _
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started _�� r _.
{
within 180 days of issuance, or if work is Suspended for more
than 180 days.
fermitteN Sicrratr_rr~e :
I s s+.red P v:
Call fciv- inspection — 6.39•-4175
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City of Tigard PLUMBING PERMIT Planck/Rec. #
13125 sw Hall Bird. APPLICATION Psrn,ii, # 2_L'1 1 - 59
i'igard, OP 97223
(503) 639-4171
•• a, ascription
ORS 81421-610 (]TYPRICE AMT
Job FIXTURES
Address --
/GA/ Lavatory ;
Tub or I u ower Comb.
i i�/� ower n y
��--.,,, alar i.`loset •' f �
7�M� s ���✓U Dishwasher
Owner
r
r� Garbage ispo
Washing me 7.50
„. Floor Drain _
Water Heater
- Ea-undry Room tray _
Occupant —Urinal
v t ofix u� fes peG
-IP—im—
MISCELLANEOUS
Contractor
sewer Ist 100
,� —;�.—rr •• wer ea.
ater service s - — -
re y acknowl6age that I have read is applicatm,that the Water Service ea. Addit.200' 15.00 --
information given is correct,that I am d,,,e owner or authorized agent of Storm 8 Rain Drain 1st 100' 30.00
the owner,that plans submitted are in compliance with State laws,that I
am registered with the Construction Contractor's Board,that the number Storm d Rain Drain Addit 100' 15.00
given is correct. (If exempt from State registration,please give reason
below) Mobile Home Space 25,00
Back ow Prevention
Device or Anti-Pollution Device 7.50
LIM Any I rap or waste Not
Connected to a Fixture 750
ern w new a i5&
alteration ion repair alc asm 7.50
to be rlone residential I& ncn-iesidential Q 40.00
Insp.of Exist.Plumbing per hr
Specially Requested Inspections per hr
Existing use of Rain Orain, single family
building or property_ dwelling 15.00
--Residential baTc ow prevention
devices 1500 I
Proposed use of -
building or property
xcep resriffal bac ow
prevention devices) _ T_-
NOTICE *Minimum Fee$25.00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 1.5%SURCHARGE
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF -
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED PLAN REVIEW 25%OF SUBTOTAL
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. TOTAL �} J
Special Conditions __ --- ----�—� -
Date issued_ _by
wrtuuer►rt
p
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" (�a'rr (:IF RIA, a.F•'r ('1Fpr-)yME;'hli RECATPI No. 994—P51442
C.IHEC;I'. 0110UN T 1.13„ 13 Y
d *ifil`!E a CLARK, R UA<, 0. CASH A110111,11, a N. 011
IDDF(F:.W., a 1,c'(Jt:'S SW MONZANT'r'f) Cl G'FaYlhl:.N r I)4•I i h e Nfi/r.+'(<)/":)4 I
r'IGARD, OFt ;iiJJfJ):I:V.L4yTC1N a
'UF2Pr]frK OF VlOYMF:'N"r• AMOUNT PAI'D F,UI:P0SI.:. C1F. F'(aYPiF.hl r f•lihC11lhl r F'Fa:l:i)
_..._.,..._._......w_.... ........
•�'L_UNRTNO PFRM PI i'l94....F1UWy,:) ,'-rM r,�' j _ I
IIII'111... AMOUNT F,ATD _ ) 1.8 . 37
fr
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