11187 SW SUMMER LAKE DRIVE i
11187 SW Summerlake Dr.
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T { CITY OSE TIGARD
.
-. 7..,.--...
-. OREGON F. N. .
Owner: Don Morissette Permit No.
891309
PO Box 19524 Portland, Oregon 97219 j
' Address:
Address- 11187 8W summerlake Dr.
Building s' R7PD
y &, R3Bldg. Type_
occupancy:- Land Use Zone:
Comments:
9 t`� day of January 7.,.I
Certificate is hereby given this •, ,-,. c..
r
that said building may be occupied and that it complies with al:
j de for the City of Tigard, as approved '
c
requirements of the Build_ng Co r ' JP
�
t� q
% �►t L by the Tigard City Council.
�, t W.
■ t ,, `� Fire Dept. Building IizsFeeta�
f Builth Official n
*
; ,. Post Certificate in Conspicuous Place
--- —
....... - , # .
TI
4
�
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y '- �,: wt:, , 2 -T .t... M4M - .i ..... M1�- �iLY:;'}� ..', �r�-= _ d•,..
_`;x ��I ,�4���,. 'i�pkr�� ?k3ty5"«e�{�,Y�W` _.:l..ia.• ,tae`":ta"'>F�-'.'•C� •�`+- -�\��� \,��-_ - `�' .,s.,..:+..
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phon,,: 639-4175
Type of Inspection _
Date Requested I Time _�A�.I,& P.M.
Address
Owner _ __.. _ Lot #—_—
Builder _
The following Building Code deficiencies arti required to be corrected:
Presented to ❑ Ap ved
Inspector —_ Disapproved
Date
CALL FOR REINSPECTION
E
Y E 8 Ll NO
MWARIN
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 839-4175
Type of Inspection
Date Requested Tim A.M.�_�P.M.
Address
Owner — Lot #
Builder
The following Building Code deficiencies are required to be corrected:
Presented to _ ❑ Approved
Inspector f �— '— �— Disapproved
Date
CALL FOR REINSPECTION
YES 0 NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested / Tjme P.M.
Address
Owner _. _ Lot #
Builder
The following Building .'ode deficiencies are required to he corrected:
wwwe-
Presented to A proved
Inspector ❑ Disapproved
Date ---- 2--
CALL FOR REINSPECTION
Cl YES 0 No
m1W
INSPECTION NOTICE
City of Tigard Building Department
P U. Box 23397
Tigard, Oregon 97223 /
Phone: 639-4175
Type of Inspection
,,7 As
Data Requested_^— ---_— Ti a_ A.M. M.
Address ///yq / mit
Owner _ _— Lot #
Builder
The following Building Code doficiencies are re�auired to be corrected:
- . _ -
--
'r "(-"YQ S ,. tA A-
. -
dLAA,4 -w\.,o
Presented to Approved
Inspector ___ — � il Disapproved
Date %-Aqo
CALL FOR REINSPECTION
❑ YES ❑ NO
INSP.:CTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175 1, J
Type of Intpectlon ------�� .c _—
Date Requested � Time � A.M.. -P.M.
Address Permit
Owner __-- - Lot #
Budder �l .
The following Building Code deficit;i(.ies are acquired to be correcten•
Presented to
Approved
Inspector
--- �� Disvproved
Date
CALL. FOR REINSPECTION
❑ YES C] No
INSPECTION NOTICE
City of Tigard Building Department i
P O. Box 23397 d
l igard, Oregon 97223
Phone: 639-4175
Type of inspection ..LLQ_ --
Date Requested_ / Time--_.. A.M. P.M.
r�
Address —/ ,.e7� +-�� t �''; -- Permit
Owner _ _____— Lot #TBuilder D
he following Building Code deficiencies are required to be corrected:
Presented to _ _.___ { Apprnvpd
Inspecter �� Disapproved
Date __L!—z z 101
CALL FOR REINSPECTION
r
0 YES L7 NO
INSPECTION NOTICE
City of Tigard Building Department u
P.O. Box 23397
Tigard, Oregon 97223
Phone 639-4175
i
Type of Inspection
Date Requested.. Time__— A
Address IZZF-7 9lZrltrli-SezleA 4-=::� Permit #�_ 7/ &
Owner / _ _ Lot #
Builder
The following Building Code defieienr`•ls are required to be corrected:
r
Preseotr?d to __ APp roved
Inspector ❑ Disapproved
Date
CALL FOR Ri;INSPWTION
[] YES 1-11 NO
ra
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 2397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection -�
Date Requested 7 Time_ A.h1M.
Address Permit 4�,
Owner _ Lot # —
Builder
The following Building Code deficiencies are required to be corrected.
Presented to ❑ Approved
Inspector Dleepproved
Date
CALL FOR REINSPECTION
7"� YES 0 NO
INSPECTION NOTICE
City of Tigard Building Department
P O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested. Time__
Address Permit
Owner Lot
� P.M.Pm
Builder r/w Z22 i4 -1
The followinq Building Code deficiencies are required to be corrected:
ell
Presented to ❑ Approved
Inspector g'ti sapproved
Date Re
CALL FOR REINSPECTION
El YES P NO
INSPECTION NOTICE
City of Tigard Building Department
F O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection --
Date Requestedd / Time �' A.M.__P.M.
1.7
Address L z ermit
Owner .� Lot #--^—_—.�,
r.?
BuilderThe following Building Code deficiencies are required to be corrected:
Presented to ._— __ _ L�Approved
Inspector �- ' --G _____.__....,. ❑ Disapproved
Date
CALL FOR REINSPECTION
0 YES ❑ NO
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.
Address ZZ �+�/�72'��LP."`"` a -� _ - Permit U
Ownerf�J Lot # _.
BuilderThe followitig Building Code deficiencies are required to be corrected:
i
-
Presented to _ -- --- Approved
Inspector -_ __-_ D Disapproved
Date - -- —-
CALL FOR REINSPF,CTION
[J YE8 0 NO
1
I
INSPECTION NOTICE
/S City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection —
Date Requested —_ Ti M. P.M.
Address _ ermit #–sT –LAG-1
_ #
Owner Lot_. --T---
Builder
'The following Building Code deficiencies are required to be corrected:
Presented to _ — -- -- ----- Approved
Inspectorr' Disapproved
Date 7� - � –
CALL FOR REINSPECTION
0 YES D NO
CITY OF T'FA D HIIJ'TILDINC. 1.A.'1 1.
NO. V . 91'A3
09
CITYWOFM TWW
A
COMMUNITY DEvr1OPMENT DEPARTMENT 0 IO E ISSU11:11) : S/ 1/09
00,00N
1312S&W Hall Blvd.,P.O.Bn 3397.Tigard.Oregon(37223 (503)639-4175 m . r)m r .NO .
L31i11.30 S'
11187 aW SUMMEHLAKE DR
TAX MAP/1-07' I.L53. 3 3AD 1:5500 SUB: SUMNEW1 AKE: L T* :36 VIK ,
I AND USE : 147PI)
LXXT SIZE: VALUATION : Ih Biel 1585
1-- 20 PE Alt 1.
WORK Cl...ASS : NEW DWELL .UN11*5 : 1 13 RIGHT' .
USE i'YPE: sINULF.:: FAMILY NO. BF.J)ROOMS : 3 EXT .WALL CONST
(:,UNC;'T' . TYPE : VN NO. I3.A7115 : 2 N: 15 : E W
OCCUP . GRP. 1-13 P1107' .
OCC'UP.LOAD N S E W
A1-EA: 1.01.6
N0. ST 0 1--4 3:E 5 1 1.ST 1(3:1.6 ROOF CONST: C FIRE 1-tl::**1.'7
:1.6 2ND AREA SE PAA7 RATED:
1.)A5r.-"MENT'? 31-11) : (:)(:,'CUl:'. SEPAP? 1:4 A T E:1):
MEZZANINI.E.'.7 RASEM' 'T
PI-T)OP LOAD: zio GARAGE : '(400 FIRE SP11:41fl.-W7 AI AP117
TYPE: Gv A S I-11)("P. ACCESS'7
PLAN (,Hl--:C.K 14Y : i-it
I..,FMAPKS :
I�ei fill!;1.14n n4l r)(el-lflit' 4:890*796 REISSUE 01::' NO.
!1130 Tor 1•e(1 I AS*r PEISSUE
- - --�1
FEki:S :
0 M(:)RJ.55ET*7*1-.-. DON T $376 00
W
N Ptl MIX 19.15Pel PLAN 14r-*..V',I:F.:W $40 00
E 1:)a I,t:L ail.n d or. 9721.9 FINk DEPT
11!'503) kP44-931-1STATE. 'TAX 111.9 . dl 0
OTHER *30 . 00
C DEVEI OPMENT CHARGES :
0 MO 1:415 5 ETTE DUM 'SDC,,(S*TO 1:4 M 1 $V50 . 00
N 1)(:)N MOR.ISt.ir.*
T bcDUT1.11")EPS INC. SEX,( SI'AFE'T'll 1111600 . 00
R P13 .)X 19.5. .'!A $P50 . 00
A p c)I- t,.I.o rt(.I cil.
C r)RF.-'PA1'D < 111110 , 00)
T V-1-40NE (503) '..?44 9:31-1
0 PF:.G:1.'S'T'1-1A'T'TDN NU. *3,55*33
R $1 '525 . 'to
*'E:Il-'I' NO
This permit is issued cubjGi to the regulations contained In Title 14 -•••••--••w••••••••••- ......
of the TMC, State of Oregon Specially Codes,zoning regulations PEQUJ:Rr-.-D INSPEC-11-IONS
Find all other applicable codes and ordinances. and It Is hereby
-cordance with the plans and EW1:.'.A
agreed that the work will be done in a S
FU(Tr I N(.,
specifications and In compliance with all applicable codes and F(JUNDATION WALL.. RAIN DRAINS
ordinances The issuance of this permit does not waive restrictive POSI' & 1:.4EAM WATE.R LINE.
covenants. Contractor and subcontractors shall have current city PI.JA.tJNI)I-'-*RSI-Aa APPI:U:H/9W
business tax permits. This permit will expire and become null and 51 AM
void If work is not started within 180 days.or if work is suspended or
abandoned for a period of 180 days any time after work has PLS . TOPOU'r
commenced It shall be the responsibility 67]% permittee to assure FPAM:[N(.'s
4 _%
all required sp tions are requested a t app"ved,
required (SAS LINE
INSUI-Al-TON
GYP - BOARD
Permitte re
Issued By: I F-00 U,612611-1 -1-UN
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
T
CITYOFT167ARD (CITAP
!iiNO..a GF:ItM:I r
�, G!�,r+M�:-r NlJ. !31.H'i)13i?7 (�
TWARD
COMMUNITY DEVELOPMENT DEPAPTMENT I)A'1 E_ ISSUED: B/ 7/89
13125 S.W.Mall Blvd..P.O.Box 23397.Tigard,Oregon 97223,(503)639-4175
--_-----------_____-- F)F2:I:M . PMT.NO. E391309
.JOD ADlaPl":SS : 11187 SW SUMMEEAL.AKE DIS USA NUMFJE W: 39014
TAX MAP/I_UT 1.51 33AD 15500 SUS: SIJMMERL.AKF' LT :36 HK :
LAND I. 'A'.' : A7PD
1 04 SIZE:
SECTION: 33 'T'WP: IS nNG: 1.w
W(: WI( ('.A.ASS : NEW
USE 'T'YPE.: S1:N(.'4L1": FAMILY
i11r1 i!ll:)I):L1.(:?iil.r►t. a►c1relf.11s tl3 ComP:l.y w:i i'l•1 at:l.a. rl.l;l.r:•ra alrlci I,e( ctl.att:i.orl :i cif tho, i.lrl:' fJ(.40
St.:awera.go, Age)n(:y . T IIr..?! l:)mar`Ini t. e1xl:):i.rC!s 1e20 (irtyls -From t.h1(.-a (:WLU-i•? i 14154.led . 1'11(:? t.ot.ia.:l.
allnul.11-It. 1:)stili will. be? -FIarTe:i.te?d :i.•P t.htra I:)(armi.t, e?xr)3.rew . The 0gency dcle?xi r .t gclall`
all.ntoe. th to atcet.trac-'y 0-1F the :l tic(altion o-l� the! tsi(:Iti? !?i(llmiel" 1.i1.t(BI"t�l.!:l . 1.-F i.hl6', ^S(:?WlPI- :I.!:-
.I
3.1:mutis!(:1 tilt thc.i In 4:?i8 fi 1.11"tamp n1, y1:LVc?rl , thio :1.1-14%tilt 11.:l 0 r !!ih16t1A. I:)1`(:IWI:)e?O t. 3 Feet, ill
all clirettionta -rrom t,h)e:A cl:iiata)nc.,' ca i.`.c„r1 . :I:f not !sla :1.ocal.t.F:?ci , t.hici! :i.n!iiti!t.L1�r w -iiai.:1.
PI.Ir`C:hatiio iii —1'ia.l:) iii,ricl Sial(• C)(i?wtor” P l'In:i.t. iltl•1(i the Acler.n(`y W:i.17.
1:NS T'AI...I— TYPE(:. : BIXI:I...D'ENG SI":WE P 1:M1)fi:raV:I:(11.1, APF:A
1•::LX'T'IJPE I.1N:I:TS : i'F::N11N1' ;I'Mr`rat:)VFME",N1' :
DWI"I_I...:GN(b UNITS ; 1.
F�F:F:S
W ;;:)Ia1 S!iE::r'1'E-K DUN f)F r2M:f.'r 11113.05 . 00
N P13 PDX 1.'i)'.121(1 C(')NNF:[:T:I UN CHARGE tli 1. ,P.50 . 00
E port:l.ianrl or` 9'7R151 1 1N T"AI> :I:NFiT'AI_-L.
R
1:)IW(:)NE:' (503) r.AZI...S)31A
(:1'1'hiF 11
C
O M0r2:I:SS1":'1'TK DON
N DON M(:11a:CFiSE:'i'TF' E11.11:I...DF:IIS :l:N(.
T
A 1:)(.1 14OX 1.91521(1
C Por t:1.1&I'ld or 97P19
TT I:'I-1UNEi: (503) P.144-9314
R W1:":. i:l:!ii'VWA ll 111:1N N1. 55?i:3 'TUTAL. (113 . UO
Kll»'CE J:PT NO. �--
i his permit is Issued subject to the regulat ons contained in Title 14 _•__, �__�_ _ �_ .. .__
of the TMC. State of Oregon Specialty„odes.zoning regulations
and all other applicable codes and ordinances, and it is hereby ITHtAUIRE:TJ INSPMI UNS
agreed that the work will be Jone in accordance with the plans and r7OUGH^-114
specifications and in compliance with all applicable codes and
ordinances. The issuance of this permit does not waive estrictive
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 days,or If work is suspended or
abandoned for a period of 180 days any time after work has
commenced It shall be the responsibility of the permittee to assure
SII required in )eions are requested and approved
Permittee . ature
Issued By: T'7rTRt-253'T x]7'1 --
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
MI:.'.Cl,-lAN1'A..AL. i:)Enwt� r
CITY OF TIGA RD WYOFMAN PE-PIOIT I. NO. : ME:991326
COMMUNITY DEVELOPMENT DEPARTMENT
13125 S.W.Hall Blvd..P.O.Box 23397,Tigard.Oregon 97223.(503)639-4175 OATE: Ichit E.,13: H/ 7/89
J014 AOURESS . 1.1.187 SW SUIMIME':1411 A K E.' n1-1
'T'AX MAP/1-01' 151 33AD 1,45!:300 SUB: SUMME.11411 AKE i...'r : '.'w) HK
LAND USE: P7113101
I-OT SIZE...
I'VEM : NO : NO:
W(:)PK CLASS: Nl::.W F-11W, 4CE <1001< 1. AIP HANDL.R <10
UISE.: VYPE: SIN('.-;LF. FAMILY F'1.1l4NACE 11,00110- A11:4 HANDLR 10K
(:.ON!5*T*. TYPE: VN V I...(:0A FURNACE*. EVAN.
OU'LIPA'.44P. : 1:43 I-IF'ATIiJil VENT FAN 2.
VENT VENT' . SYS1*11EM
81-1-4/ClOMP <31-11-1 1-11OL10 1
NO. iiiT()RIES : :1. HLR/COMP '.3-1.5HP :l:NCINEAA'T'OP(D(:)M
DWELL .UNITS : 1. 1,3--:30HIJ IN(:'INErtA*T'(:)I:,(('.OM
FUEL I'YPF' GAS 181L17/C,'OMP ':30•-•5()H1-' REPAIP UNITS
MAX . INPUT OLP/cOmp 50+I-IP ('YTHE'll 2
V'IPE:: 17MPP57 GA5 P*.I'F,I*NG OLITLE'rs, 1.
H I(.,;1-1 P r'll 1'.5!:;
WEMAHKS ,
0 FEE:S :
W
N
DON r+'PM I F 1.0 0
MOP'SS' -T .1"
E F)n DOX :1.9,,$i.'.2,el 1.11 AN 1-41EVIEW 3!
p a I-t I IL 1-1(1 ul• 97P19 F'IX1*1JPE'G 5
(,503) PIA 93:14 S'TATE TAX
C OTHEP
0
N
T
R L. HEAT'l:N(.*, INC .
C A 15'.'-50451:;: PTAZZA AVE
T GLAUKAMAS 0P 97015
0 1:"HONF-.- ( :103) 243 1.1 FIA
R
blill 44-1 TO'T'AL_ $418. 76
This permit is issued subject to the regulations contained In Title 14 1.1E('.1 1 N'T' N0
of the TMC, State of Oregon Specialty Codes, toning regulationq.
and all other applicable codes and ordinances, and It Is hereby
agreed that the work will be done in accordance with the plans and
specifications and In compliance with all applicable codes and GAS L INE.
ordinances. The issuance of this permit-toes not waive restrictive Posr & FW-AM
covenants. Contractor and subcontractors shall have current city WOUGH I N
business tax permits. This permit will expire and become null and
I-
void If work Is not started within,180 days,or It work Is suspended or T NAL
abandoned for a period of 180 days any time after work has
commenced.1t, 1he the responsibility of the permittee to assure
ul ad
all on ir p tions are requested and approved
Pp,rtnilteee gnature
Issued By ("AI...I._ FOP TINSPEt—TAGN 639-41175
SEPARATE PERMITS REQUIRED FOR WORK OTHdr-*H THAN DESCRIBED ABOVE
UUUU UUUU IUL —I
CITY OF TIFA RD /ir�� ISI„,UMBING; IDI*:'AM J*T
CITY01FTWARD PERMI'T' NO V 1. a 9 3.3;.?
COMMUNITY DEVELOPMENT DEPARTMENT
13125 S.W.Hall Blvd.,P.O.Box 23397,Tigard,Oregon U223,(503)639-417 5 [)A'I 1:1: 0 69
I.M.1 rl . I 3M I NO . 0501,09
J08 ADDI4lE:5!-.'o : 1.1-1-87 15W 'SUMMEPLAKI-K' DP
TAX MAI:.,/I 0*1, IS1. XZiAD V'5500 SUB: SUMMIERILAKE'. L T : :56 13 K
LAND USF: ;
I. (XI 5,1.,ZE::
I TF.M NO . NO
WORK C',l ASS : NE-W
WATI'-,J4 CLOSEA
USE: TYPE. : FAMD Y t.)P'.I'.NAI RKI`-:'L()W PPVN 1114
CONST . 1 YPV,;.: VN L AV 0 A A'Y'(:)R Y is T r4AP V,Fn Mcl-1
OCCUP.UPP. ; 1-13 'I'LIH SHOWE:14 714APS
D1:SHWA! FI E.A J.
01SPOSAL
NO. STUPIES : J. WAST-EYNGs MACK(NIX
UNITS : 1. 1 AUNDPY TRAY
I*z'L,(.')L)R DPATIN
SINK 1. SE WEA (1::*y )
W A A FI E A"Y E 14 51134M/NATINI (FT
0 F EES :
W
N MOP 1:SSE:' DON 1.:13 . 11)
E pa BOX 1.952'el
p c)I-,t:1.a n d ar 91P1Y F.1,X-1
PFIONFF (503) 241A 9*31 A s,rA'T'E TAX $5 .80
G UFHER
0
N 43 1-10 E:M A I<e A HAP1131-0
T *
R SI--I(:)F'MAKE:P I G 1::,l I J M ti-I I N(.,
C A 111:) 1:30X 250
T es taciacla ar 97003
0 (50 3) 630-7728
I i3:3 . 3 1:3
This permit is issued subject tc the regulations contained In Title 14 PIECE I P'T NO
of the TMC, State of Oregon i1pecialty Codes, zoning regulations
and all other applicable codes ;nd ordinances. and It Is hereby
12F.-*QU1RE*.I'.) XNSPEC .(:INS
agreed that the work will be done In accordance with the plans and
specifications and In compliance with all applicable codes and PL.B.UNDE3151..-AR
ordinances. The issuance of this permit does not waive restrictive & 14r--.AM
covenants. Contractor and subcontractors shall have current city WA'T'ER LANE:
business tax permits.This permit will expire and become null and 1:1-13. TOP001'
void It work Is not started within 180 days,or It work is suspended or
abandoned for a period of 180 days any time after work has 14A.I:N DRAIN!i
commenced It shall be the responsibility of the permittee to Mum 1-1.NAL_
all required In)ctions are,requested nd approved.
'u'rea
Permit4teell re
Issued By- -1 011 1 0114 10N 6.39--1.1 t!)
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
Wit xlw_K��E
CITY OF TIGA RD PLAN CHECK APPLICATION
OWOF 1Gx� PLAN CHECK N c.
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT N ----
11125 S.W.44A 81wd-P.O.9oa 23797.Tkad,Oie"i 2MU.('117)6J94175 h
\ DATE ISSUED
JOB ADDRESS: 111'8 7 w' 1",�' l ►� !��• --- i AX MAP/LOT
SUB: �U��, c —c x� LOT: _��--- LAND USE: ---- -- --
VALUATION: r�,R S_0
OWNER � // SPECIAL NOTES
NAME: r� 1YlO�ls.�L'�C3' �LC�S-I_ ___ REISSUE OF: _^
ADDRESS: LAST REISSUE:
Fl_000 PLAIN/
SENSITIV` LAND:
PHONE: --
APPROVALS REQUIRED
CONTRACTOR PLANNING: -
NAME: ENGINEERING: —
ADDRESS: FIRE DEPT
OTHER:
PHONE: ITEMS REQUIRED
LIST/SUBCONTRACTORS:
ARCH/CNGINEER BUS TAX: —
NAME: _ I � c I I�/ - c��, CALCULATIONS: - --
ADDRESS_ TRUSS DETAILS:
PARKING PLAN:
LANDSCAPE PLAN:
PHONE: _ _ -- OTHER: ---
(XkY1ENTS:
PERMIT N ACCT N DESCRIPTION AMOUNT AMOUNT P0. DAL. DUE
C/ 'U 10-432 00 Building Permit Fees _13-hL,_ 7�,- -
.2 10-431 00 Plumbing Permit Fees -L Z.so u
10-431 01 Mechanical Permit Fees -37,.50 y 7�7 jo
10-230 01 State Building Tax (5%)
Building 7 ),.210 "_
Plumbing S,frk
Mech I , .-
10-433 (10 Plans Check Fee ,.�d f►^' �,3� U� c �'
Building U �'U fo`►,if�t�
Plumbing
Mecl1
30-207 00 Sewer Connection _
30-444 00 Sewer Inspection
51--448 00 Street System Dev Charge (_OC) eo G)U Y __0
52.-449 00 Parks System Dev Charge (POC)
31-450 00 Sturm Drainage Syst Dev Chrg (SSK)
10--230 09 TRFO
10-230 OG Washington County fire N1 (95X) —
10-'_ Amart/wo wood
REC N
APPLICANT SIGNATURE --^— --- ---- �I '
Pec(,i ved BY: _ Date Received:
cn/3587P/i8P