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rzI d �y''9. CITY OF TIGARD BUILDING INSPECTION NOTICE "
Ins
pectiun Line: 639-4175 Business Phone: 639-4171
Footing Rain DrainCover/ServiceFINAL: �' r�'� ',
Foundation WatAr Line Ceiling '�
Plumb, � s'�u
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Post'Beam Mach. Shear/Sheath
Framing -Mach.
Plbg.Und/Flr/SElect
lab Plbg. Top Out Insulation
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Post'Beam Struct. Mach. Rough-in Gyp. Bd.
San. Sewer -Bldg.
Appr/Sdwlk Reins. '
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Address: Entry:
Tenant:
Ste: MST:
F��y Con/Cwn: BLIP:
PLM:41
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Inspector: -
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_-APPROVED DISA-PROVE D/CALL FOR REINSP. CF CO
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i CITY OF TIGARD BUILDING INSPECTION NOTICE
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Inseection Line: 639-4175 Busineas Phone: 639-4171
Footing Rain Drain
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Cover/Service FINAL:
FOUndatiC n
a r' Water Line
Gelling
��,H `,, ref r ;�r`•� � -Plumb.
Post/Bearn Mech. Shear/Sheath Framing
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j Plbg,Und/Flr/Slab Plbg. Top Out Insulation
f -Elect.
Post/Beam Struct, Mach, Rough-in Gyp, Bd.
San. Sewer A r Bldg.
Gas Line pp/Sdwlk
Reins.
Other: ( 7
Date:
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Address: — S W — Ent
Tenant: `
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THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector:
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—APPROVED —DISAPPROVED/CALL FOR REINSP. �
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A M ROIRT'AIYT-MESSAGE
FOR
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GATE -°_� _TIME P.M.
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PHONE.�ill0
ARlA CODE NUMBER FXTENRION i
TELEPHONED j __ PLEASE.CALL j
CAME TO SEE.YOU �WILL CALL AGAIN
WAN'S TO SEE YOU RUSH
RETURNED YOUR CALL SPECIAL ATTENTION
MESSAGE,
SIGNED
" LITHO IN UR A.
TOTAL OFFICE PRODUCTS TOPS 30025
and printers, Inc. 228-2395
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CITY OF TIGARD BUILDING INSPECTION NOTICE �! two;,t`I
Inspection Line (Rec-O-Phone): 939-4175 Business Phone: 639.4171 "y` 4 '.
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mach. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewers Lino -'Ildg.
Plbg. Underfloor Rain Drain Framing -Plumb.
!T
Alan Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: ZC?� Time: AM PM
Address: �� a�- C.'
Builder._Q www _ 3Gr� t Permi' sf:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: _ Dater/0'14�
_APPROVED _DISAPPROVED 'APPROVED SUBJECT TO ABOVE
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_Call For Reinsp.
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MECHANICAL
CITY OF TIGARD PERMITPE��MIT #. . MEC95--0343
1t7�/al�„9
COMMUNITY DEVELOPMENT 6EAR
� HI&NT DAFE ISSUED:
13125 SW Hall Blvd.Tigard,Oregon 97223.6199 (503)639.4171
PARCEL: 25;114A}3-0700
SITE ADDRESS. . . : Z0240, CSW 11'1._L_EN F)R
SUBD I V 15 1 ON. . . . : KNEELAND F.:STATES ZONING: R-4. 5 + •
BLOCK. . . . . . . . . . I. 0"F. . . .. . . . . . . . . . : 14
CLASS OF' WORIN,. . :ADD FLOOR FURN. . . . : EVAC COOLERS: •
TYPE OF LtSE. . . . :SF UNIT HEATERS. . - VENT FANS. . . :
OCCUPANCY GRP. . : R3 VEN'T'S W/O 7PPL: VENT SYSTEMS:
S"TORIES. . . . . . . . :2 BOILER S/COMPRESSORS HOODS. . . . . . . s
FUl=1_ TYPES______.___._ ___ 0_31 HP. . . . . DOME((). INCIN:
-/GAS/ / / 3-J5 HP. . . . : COMML. INCIN:
MAX INPUT: BTU 15-30 HP. . . . : REPAIR UNITS:
FIRE DAMPERS?. . : 30--50 HP. . . . : WOODSTOVES. . :
GAS PRESSURE. . . 50+ Fir"'. . . . c CLO DRYERS. . :
NO. OF : "y.t"I'S.__..__._.._..__.._._.__ AIR HANDLING UNITS OTHER UNITS, ;
TURN ( 1001-/, BTU: (= 10000 CFM : GAS OUTLETS. »:
FURN > =J.00K BTU: > 10000 Cfm ;
Remarks : Install gaS pipi.nl
BENTON AND CARY 1-101_71WARTFI type -AM oUnt by (Jat• a r^ec:pt
9240 )W MIL_LEN PRMT $ 25. 00 JSD 10/05/95 95--271333
:-iPCT $ 1. 25 ,.lSD 10/05/95 95-271333
TIGARD OR 97224
Phone #:
Coil Lr—ac--t nr^:
GRIMSON COMPANY INC
9970 SW SERENA WPY
T 1 iARD OR 97224
Pllio ie #» 503-620-3678 $ 26. 25 TOTAL
Reg W. : -1,6974
--- ---- REQUIRED RED I NSP["CTI ONS
This permit is issued subject to the regulations contained in the Mechanic-al Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
applicable laws. All work will be cone in accordance with
approved plans. This permit will expire if work is not started
within 188 days of issuence, or if work is suspended for more _____,_, ..____•_.�___.__.__ __ _.____._.�_..______._..._
than 180 days.
per mittee L—A+Rt"tl_1r,
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Call far inspect ion - 639-4175
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City 9 of Tigard MECHANICAL PERMIT Planck/Rec. #
13125 sw Han Blvd. APPLICATION Permit # �1CC5--a3�/-s h ', ,,.,'"''.
Tigard, OR 97223
(503) 639-4171
Description
Table 3A Mechanical Code CITY PRICE AMT �
JobGf(� �'�,CJ {�.l �� � 1) Permit Fee -0- -o- 10.00
Address
T t C.^-4- UYz 727 4- 2) Supplemental Permit 3.00 �w
"•'""""•° "• Furnace to MUM --
' 1) incl. ducts &vents 6.00
a ••• Furnace +
Owner � t_ 2) incl. ducts 3 vents 7.50
•• - Floor Furnanco
3) incl. vent 6.00
—�— - •'«"•^•^ — Suspended eater, wall heater
v 4) or floor mounted heater 600
Occupant ... «' Vent no incl. In
" 5) appliance permit 3.00
u •• *' Repair of eating, refrig.
6) cooling, absorption unit 6,00
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Boiler or comp, heat pump, air cond.
C), ��C� 7) to 3 HP, absorp unit to 100K BTU 6.00 1
=�--� o,er or comp, heat pump, air cond.
Contractor U '�W tP1UA WAC 8) 3.15 HP; absorp omit to 500K BTU 11.90 �I
�' '• p�
Boiler or comp, hT eaf pump, air con
Z (� (= r 1� ,' �' 7�z 9) 15-30 HP; absorp unit .5-1 mil BTU 15.00
•°""•'°" of er or'com`pTeat pump, air cond.
✓F C 4 eq
7 10) 30-50 HP; absorp unit 1-1.75 mil BTU 22.50
hereby acknowledge that�1Tave read s application, t at the Boiler or comp, heat pump, air cond,
information given is correct, that 1 am the owner or authorized 11) > 50 HP; absorp unit 1.75 mil BTU 37.50
agent of the owner, that plans submitted are in compliance with Air handling unit o
State laws, that I am registered with the Construction Contractor's 12) 10,000 CFM 4.50
Board, that the number given is correct. (If exempt from State Air an ing urn
registration, please give reason below.) ,3) 10.000 CTM + 750
—Wo_ri-porta_6Te_
11) ?vapoiate cooler 4.50
— Vent connecte --
151 to a single duct 3.00
Anti atlon system not
16) rnclu0t! in appliance permit 4 50
,.w,. o." •. �oocT serve7Ty i
cl-- Jam"V,.:, 17) mechanical exhaust 450
scrl e w r new addition ( a teration repair ommeraa or n ustna -
fo be done residential 0 non-residential Cl 18) type incinerator 3000
Existing use o 1Other ,e., woa stove, water
budding or pruoerty r-yr, 19) heater, solar, clothes dryers. etc. 450
Proposed use of 20) Gas piping on, to four o,itlets2 00
building or property T ?1"A"L '�
Type of fuel -oil 0 natural gas LPG (D 21) More than 4--per outlet (each) 2.00 electric Q --- - —
Minimum Fee 325.00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION —— I
AUTHORIZED IS NOT CnMMENCED WITHIN 180 DAYS. OR 591. SURCHARGE `S
IF CONSTRUCTION OR WORK IS SUSPENDED OR --
ABF,NDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25% OF SUBTOTAL
AFTER WORK IS COMMENCED
TOTAL
Special Conditiuns L --
t Date Issued _ by
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INSPECTION NOTICE
City ..i Tigard Building Department
Oregon
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13125 SA Bull Blvd, Tigard, Oregongon9797223 C
Inspection Line (Rec-o-Phone: 639-4.175 Bueinens Phone-1-639-4171
Inspection:
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Can Line FINALS
Poet/Beam Struct. San. Sewer Framing -Bldg. `
Poet/Beam Mach. Rain Dr4in Insulation
Plbg. Underfloor Water Line Gyp. Bd. -Hoch.
Date Requeatodds / ~ 7_-rl _Time: PM
Address:
Builders L^
THE FOLLOWI CORRECTIONS ARE REQUIRED:
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Inspector Dates4-2- i
APPROVED UISAPPROVFD
_---.. APPROVED SUBJECT TO ABOVE
Call For Reinsp.
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Zti PECTION NOTICE.
city of Tigard Building Department
13125 SW Hall Blvd. Tigard, oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Busi.nese Phone: 639-4171
Inspections -- -— —
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Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/seam Struct. San. Sewer Framing -Bldg. r
Poet/Beam Much. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Date Requested:l Times AM �PM
Address:�c��(„i r d GAG ` �� _ Permit
eulldar:---- tai=_'�.I-SL—�� .--_— --
THE FOLLOWING OORRE NS ARE REQUIRED:
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Inspectors`/ ' ' ---- Date:. r
APPROVED _ _ DISAPPROVED APPROVED SUBJECT TO ABOVE
-- Call For Reinep. r
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INSPECTION NOTICE f
City of Tigard Building DclarLffent
1.3125 SW Ball Blvd. Ti, d, Oregon 97223
Inspection Line (Rec-O--Phone): 639--105 Buninenn Phone: 639--4171
Inspections__ _ -------- -- �-
Footing Plbg. Underslab Mech. Rough-in Apgr/sdwlk
Found. Plbg. Top Out Gas Line FINALs
Pont/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor water Line Gyp�Bd -Nech.
/W Date Requested: b )
Address• Times � AM .__ PM
-` y t..J Permit r s e"
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Builder:�jl � - -------
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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j Inspector _ — _—a� Bates - /� �✓� ;
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APPRO MD DISAPPROVID APPROVED SUBJECT TO ABOVE
--- i
Cell For Reinep.
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INSPECTION NOTICE
City of Tigard Building pepartAment '�/1/f`✓_
13125 SW Full Blvd. Tigard, Oregon 97223
Tnepection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Underslab I -ch. Rough-in Appr/Sdwlk
Found. Plbg. Tap Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Hoch. Rain Drain L Insulation -Plumb.
.:r
Plbg. Underfloor Water Line Gyp. Bd. -Hech.
Date Roqueeted:—J� ___TimSe�l�2t` _ —PH
Address: / 6) ! /� -` ��� �S Permit 1:
Builder:__
THE FOLI YgING g1T11NSS AREREQUIRE.
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peto(° - ---��_... --- - -- hate:
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Pelnep.
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INSPECTION NOTICE �� G
City of Sil.yard Building Department
13125 SII Hall Blvd. Tigard, Or. 97223
Inspection Line (Rec-O-Phone): 6309--4175 urine :one: 639-4171
Inspection:__
Footing Plbg. UnderElab Ne . Rough-in Appr/Sdwlk
Found. Plbg. Top Out Cas Line FINAL:
Post/Roam Struct. San. Sower Framing -Bldg.
Poet/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor. Water Line Gyp. Bd. -Hoch.
Date Requested:� J` �� Timet AN �_PH
Address `�I✓Z�'l �!Vl.^ �" �15C/Y 'f Permit?1: I'15T 12-
Builders
Iz-Builders �70
TtIE FOLLOWING CORRECTIONS ARE REQUIPED:
Inspector
! APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
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INSPECTION NOTICE i
City of Tigard Building DepartmentC/!�. --'�
13125 SH Ball Blvd. Tigard, Oregon 9722 I
Inspection Line (Rec-o-Phone): 639-4175 Business Phone: 639-4171 I!
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Inspection•
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. /' Plbq. Top Out Gas Line FINAL-
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mach. Rain Dtain Insulation -Plumb.
Plbg. Underfloor water Lina Gyp. Bd. -Bach.
Date Requesteds '/0 -Time:� lAN P
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Address. a, ./!/�Q��. �, Permit 1:�/`
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Builder:
THE FOLLOWING CORRE IONS ARE REQUIRED:
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Inspeckors Date: i 2 S
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinep.
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INSPECTION NOTICC
City of Tigard 3uild1mg DepertLmnt
13125 SW Hall Blvd. Tigard, Oregon 97223f --'�
Inspection I1ne (Rec-O-Phone): 539-4175 Busineee Phoned 639-•4171
"fhtar Inspection:
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Footing
Plbg. Underelah Mech. Rough-in Appr/Sdwlk
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Found. Plbg. 'Pop Out Gas Line FINALS
r'�'> •, ,�/Beam 8truct. San. Sewer Framing -Bldg.
ost/Beam Mach.`i Rain Drain Insulation -Plumb.
Plbg. Underfloor water Line Gyp. ad. -Mech.
Datr. Roquested:
Time: AM PM
Permit
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Builder: 1
THE FOLLOWING RECTIONS ARE REQUIRED:
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Inspector% Date:A27
PPROVED DtSAPPROVRD APPROVED SUBJECT TO ABOVE
--Call For Reinap.
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pe r INSPECTI3N_NOTICE
City Of Tigard Bulldiug Department V -
13125 SN Ba11 Blvd. Tigard, Oregon 97223
* Inspection Line (Rec-0-Phone): 639-4115 Business Phones 639-4171
Inapection:`�
a• Footing i Plby. Undernlab Mach. Rough-in Appr/Sdwlk �n r „
,r F,-ind. Plbg. Top Out Can Line FINAL:
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Poet/Beam Struct. San. Sewer Framing -Bldg.
Posy./Beam Mach. Rain Drain Insulation -Plumb. r �
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t Plbg. Underfloor Water Line Gyp. Bd. -Mach, &1aa , ++ d
Date Requested:/ - %%L Timet AM PM
Address: !_i_ Permit #1 WW yr r
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Builder!
TUN FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: Date:
APPROVE DISAPPROVED APPROVED SUBJECT TO ABOVE
-- Call For Reinsp.
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CITYOFTIFARD MASTER PERMIT
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OFTMID PERMIT #. . . . . . . : MST92-0210
COMMUNITY DEVELOPMENT DEPARTMENT cRm®oa
13126 SW RAI BNd. P.O.Pm 23397,Tipped,Onpon 97223(600)6394176
— 639-4171-- JOIE_ LSSUED LUJ-O7019�9—
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SITE ADDRESS. . . : 09240 SW MILLEN DR PARCEL: 2S114AB-02700
SUBDIVISION. . . . : KNEELAND ESTATES ZONING: R-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . : 14
--------------------------------- BUILDING ------------------------------------- �r
REISSUE: DWELLING UNITS: 1 BASEMENI.. . . . . . . . :0 sf
CLASS OF WORK. :ADD BEDRMS:2 BATHS:3 GARAGE. . . . . . . . . . :0 sf
TYPE OF USE. . . :SF FLOOR AREAS---------- REQUIRED SETBACKS-----------
TYPE OF CONST. :5N FIRST. . . . :400 sf LEFT. . :0 ft R I GHT. :5 ft +
OCCUPANCY GRP. :R3 SECOND. . . : 162 sf F RONT. :20 ft REAR,. . :34 ft
STORIES. . . . . . . :2 THIRD. . . . :0 sf REQUIRED---------------•----
HEIGHT. . . . . . . . : 18 ft TOTAL-------:562 sf SMOKE DETECTORS. :Y
FLOOR LOAD. . . . :40 psf VALUE. . . . .: 25852 PARKING SPACES. . : 1 d
Remarks: PATH 2
---------------------------------- PLUMBING
SINKS. .a . e . . . . . :0 FLOOR DRAINS. . . . :0 BACKFLOW PREVNTRS. . :O
LAVATORIES. . . . . :4 WATER HEATERS. . . :0 TRAPS. . . . . . . . . . . . . . ..@ y'
TUB/SHOWERS. . . . :2 LiAuNDRY TRAYS. . . :0 CATCH BASINS. ., . . . . . :@
WATER CLOSETS. . :3 SEWER LINE (ft). :0 GREASE TRAPS. . . . . . . :@
DISHWASHERS. . . . :0 WATER LINE (ft) . :@ OTHER FIXTURES. . . . . :0
GARBAGE DISP. . . :0 RAIN DRAIN (ft ) . :@
WASHING MACH. . . :0 SF RAIN DRAINS. . :O
MECHANICAL -------------- ---•------------- FEES --------------
FUEL TYPES----------- UNIT HTRS. . :@ type amount by date recpt
/GAS/ / / VENTS . . . . . :4 BPRT $ 175. 00 .JH 10/07/92 -
MAX NPUT:@ BTU DENT FANS. . : 1 RPL C f 113. 75 .JLH 09/17/92 231771
FURN ( 100K . . :@ HOODS. . . . . . :0 B5PC $ 8. 75 JH 10/07/92 -
FURN )-100K . . :@ WOODSTOVES. :@ MP9T $ 31. 00 JH 10/07/92 -
FLOOR FURN. . . . :0 CLO DRYERS. : 0 MF -C $ 7. 75 JH 10/07/92 -
BUIL/CMP ( 3HP:@ OTHER UNITS:@ M5PC $ 1. 55 JH 10/07/92 -
GAS OUTLETS:@ PPRT t 67. 50 JF-1 10/07/92 --
Owner: ------------------------------------- P5PC f 3. 38 JH 10/07/92 -
BE.NTON AND CARY HOLZWARTH
9240 SW MILLEN
TIGARD OR 97224
Ph c n e x'70
Contractor:
GR.iMSON COMPANY INC
9970 SW SERENA WAY
TIGARD OR 972224
Phone #: 5Q3-620-3678
Reg #. . : 48974 _.______-------------____--.-------------
408. 68 TOTAL
This permit is issued subject to the regulations contained in the ------- REQUIRED INSPECTIONS ------
Tigard Municipal Code, State of Ore. Specialty Codes and all other Foot/found Insp Gyp Board Insp
applicable laws. All work will be done in accordance with approved Rost/Beam Stru=t Rain drain Insp
plans. This permit will expire if work is not Carted within 188 Post/Beam Mecham Mechanical Final
days of issuance, or if work is suspended for more than 188 days. FILM/Underfloor Plumb Final
Mechanical. Insp Building Final
Permittee Signatur '.; + ._ ___ ___._ Plumb fop Out Erosion Control
Framing Insp Crawl Drain
Issued By: _- -- Insulation Insp ------.-_-_._
Call for inspection - 639-4175
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CITY
`1T\ �1T�1 ,� T�`(1 131?S SW Hall Ulvd. PLNCK/RECT # fBox 23397
COMMUNI'11 DF■`NE-1,01-TVIEN'r D1■,PPAAAR,rr11MFFNT ■�!■ Tigard,Oregon972D PERMIT #
(503)6394171 DATE ISSUED
4 JOB ADDRESS: M1�'� TAX MAP/LOT2-7 W
SUB: LOT: `�_ LAND USE:
VALUATION:+
OWNER SPECIAL NOTES
NAME: _ �
REISSUE OF:
ADDRESS: M"O �'w �'=- fLR"t'th ,�ZG f�-��; LAST REISSUE: �^
-JIe FLOOD PLAIN/
PHONE: �. (/ _ SENSITIVE LAND:
f
I C APPROVALS REQUIRED
NAME: _ �' --� . �dD1 �1 ---- PLANNING:
-� ADDRESS: �zU `� "+le-e. D 4V'h9 4'TO3q- ENGINEERING:
FIRE DEPT: --- -- _ --- __-
PHONE: '� S - .'�� OTHER: ..+tV T/F— !"r --- ------
CONTR. BOARD #: EXP DATE:
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: hS-'ti f,,:
Gotai,N►�TnCZ- MECH: Ul.� C�-�.�� �"r'cQC BUS TAX:
R CALCULATIONS:
NAME: _,_ WtL,(, Ncrie�( _ TRUSS DETAILS:
�- ADDRESS: _ �._ OTHER:
PHONE:
PROPOSED BLDG. USE:
COMMENT':
00,
G
APPtffANT SIG T I
Roreived By: Date Received:
i
1,
1
5
PERMIT # ACCT # DESCRIPTION AMOUNI AMOUNT PD. BAL.. DUE
/ 51ft-OV0 10-432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees
10-431 01 Mechanical Permit Fees _ /.uo ,– _ 3/•_� -
10-230 01 State Building Tax (5%) 13, 4,
Building 8. 75_
! w
Plumbing 3. Sb�
Mechanical
j 10-433 00 Plans Check Fee 121 S'o =
Building //3 Ar
Plumbing
Mechanical ?s
10-230 06 Fire
30-202 00 Sewer Connection
30--444 00 Sewer Inspection _---_
25-448-02 Commercial TIF Fees
r 25-448-04 Industrial TIF Fees
25-448-06 Institutional TIF Fees
25-448-03 Office TIF Fees _
25-448-01 Residential Traffic Fees
25-448-05 Mass Transit TIF Fees
52-449 00 Parks System Dev Charge (PUC) _
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC)
24-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of) _
TOTAL 33�
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! CITY OF T I GARD - RECEIPT OF PAYMENT RECEIPT NO.
CHECK AMOUNT 31.7. 35
jINAME. : CRIMSON COMPANY, I Nc CASH AMOUNT r 0. 00 N I
t41)DRESB r 9970 SW SERE::NA WAY PWYlYIf"NT DATE t 10/07/92
TIGARD, OR SI.BDIVISION
n
'PURPOSE OF PAYMENT AMOUNT FIA 1 U PURPOSE OF PAYME NT AI+'OUNT FIA I D
_.__--_-_-f
_.__-...__—F:R. ._.......,. ._ .._......._._
f3lJIL.L7IN(J F�E:RM i'� i. 0�1i PLUMBING F'f=,RM E•7. �r0 y
j MECHANICAL PIF 31. 00 BUILD PER
13- 68
w PLAN CHECK F"'F 30, 1 7
I
6
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Tt7TLal. AMOUNT PAID .- -- _ ..> ,:?�1 �". ,-s:; ;
I '
r• I
CITY OF 7 DAPI) (IF FF"flYmFN`l RF CFC*I f✓'"C t%jo. 9 98w-i?3 i.771
(:HEC:K AMI"11JN'1 t 9 1. 13 3 �
IdF�hil a V0Dr'.Rb Rt:,'p, I If l`dl?Y CASH AMOUNT a p►, 00
AC)C1F'II".ss 0 t='AYME:NT DA TF. a 09/17/9c: i w�
'3UBD I V I T ON r
' � I
PURPOSE OF PAYMENT Al,,'OfJN'1- PAIL) PLJRP0Sl:_ OF PAYMENT AM00114,11, PAI
r+l_AN f HEi.'t�, F`j- __._...._._. ___..._..••.1�.1.. .M
i
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` Hf:)UWARTH R17S I DENCE;
9=40 SW MILLE:N
TOTAL AMOUNT PAID > a 1« 5