11624 SW LOMITA AVENUE 11624 SW LOMITA AVENUE
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COMMUNITY DEVELOPMENT DEPARTMENT
13125 S.W.Hall Blvd.P.O.Box 23397,Tigard.Oregon 97223.(503)6394175
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IAX MAID/L.01, SUL I F H'K :
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WORK ALATERAIJUN wo-ITF.A.4 CA-05E,T' 144AP
USA-" TYPE: 54- FAMILY UPINA- 1- Hl<r:'LOW PAVNTP I
(7C)NS1' . 1YPE'. : VN LAVE)PA'TORY 'Y'NAP PRIMEA
GAIP) . : III (AMA 51-40WER (APE ASE: TPAPS
DISIAWASHEP
GAWDIM'.91K. 1XISPOSAL
NO . 5"I'OPIE1Si : 2 WASFIINCv
I)WELL .UNI'VS . LAIANDRY TPAY Of DG . I)PAIN ( 1'.)TA
FI (JOR DWAIN
51 N K SEWEII (FA
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E P n r,V1.ilk n cI 0A 197 P. J. F'IX11)AES
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This permit is issued subject to the regulations contained in Title 14 - .•-•-.•.•..•--_.........._...
of the TIVIC. State of Oregon Specialty Codes. zoning regulations PF.-.:QLJ:I:F4E:D INSP-'XTIONS
and all other applicable codes and ordinances, and it is hereby 1111011-11GIA—IN
agreed that the work will be done in accordance with the plans and
specifications and in compliance with all applicable codes and F1 NAI
ordinances The issuance of this permit does not waive restrictive
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 it 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
all required Inspections are requested and approved.
C—
Permittee I
Issued By. ; e
e) All WA4
SEPARATE PERMITS REQUIRED FOR WORK OTHEF THAN DESCRIBED ABOVE
Address Permit No. f-6 7
Name of Occupant_._,_,______, Permit charge.......
Connection fee—
Paid by
Date connected
Type of Building Inspection fee
Service Paid by Date
Contracior Assessment
Size of connection
PERMIT TO CONNECT
City of Tigard
Permit IST° 867 DATE
,I
PERM'T IS GIVEN TO ,_�. + -jet
OF U
TO"'fONNECT A - — _ ._� `' 'r.r TO THE SYSTEM OF CITY OF TIGARD
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COMPLETED.
PERMIT FEE PAID ; _-__CITY OF TIGARD
i'
CONNECTION INSPECTED AND APPROVED
Date fuperintendent -
s.
l'.O.f3ox 2-IJ97
C ITY OI TIGJARD PLUM 131 NG 13125 EW RaU Blvd.
'i�ir� az m223
Al-4rlicants must hold Oregon Registration to conduct a plumbing
business cm must be property c wrreNoperator not hiring outside help. 1 E'.I I r fj-1-4175
Name of C)evebprnent
�L)LS-r/
Plumbing Permit No.Q1
Adore" r z Description
/���> SGL .L.Cl1� ///� (,�,- ORS 814-21810 DUAN. PRICE AMT.
Job Tax Lot Map.No. ---
Address
FIXTURES
tv Bleck Subdivision - -
Sink _ 7.50
f .eerie oTbustness Lavatory 7.50 --
/�ST/`7'G 'r S Tub orTub/Shtower Comb. 7.50
acing Address
-5-(A) snoweronly 7.50 -
Owner cityistatIt a Zip
_ - 7.50
aahwaatter --- - 7.50 ----
Phone Garbage Disposal - _ - 7.50
Name Washing Machine -- -- - 7.50
Floor Drain _ _ 7.50
ar eng Address Phone Water Healer 7'50
Ip
Occupant --- Laundry Room Tray- - 7.50
p CityiState
Urinal _ 7.50
Dime a Other Fixtures(Specify) 7.50
�._..__. 7.50
mg Address Phone - ---- - 7.50 -
Coractor CltyiState 7.50
nt
MISCELLANEOUS
City Bus Tax No. Sewer tat 100' 30.00
I 5late_s�oar-{c FTo - State t-moi m s'BusZ ic. o Sower ea.Addrt t 0015.00
--- (Residential) J _v- Water Service 1-%t 100'_ -20.00
wiedge that I have read this appW,atlon,that the inicxmatlon Water Service ea_Addit.2 a 15.00
1 hereby acknoj
given is oorr"rl,that I am registered with the State Ftui der's Board,and also Storm 6 Rain Drain t at.10030.00
have a Stale l mebing license Mat the rxxnbwe given are ccxred,that all
pkrrrrhing work wig be done in a000rdanoe with appscable provis;xrs of Oro- Storm 8 Prin Drain Addi1.10o' t 5.00
gon Revised Statutes Chapters 447 and 893 and applicable odes and that Mobile H m9 Space 25.00
no help will be en pkyed unless licensed under ORS 683. 01 exempt from ----- " -
State registretkxe,pleas"give raison below). Back Flow Prevention
HOMEOWNERS- I hereby certify,that I am the owner of the property de- Device or Anti-Pollution Device 7.50
scnbed above.at which bc•.atkrn I propose to make a pkxnbkq installation kx Any Trio or Waste Not
my own use and thio prnpaty it fxA being consbtxted for a".lease or rem Connected to a Fixture 7.50
Catch Basin 7.50
harp.of Exist Plum"-- 40.00 Per Ht.
Specialty Requested Inspections 40.00 Per Hr.
Alun of Pkwfttg wt1hin
Exis*y Bldg 15.00 m1n.
- -- -- New Bldg.a BkAld.Addition 25.00 rrAn.
AUTHORIZED SIGNATURE Det" -`- -_.
.-
Descnbe worts new I I addition I I alteration L) repair n 15.00
t be done esidenlia! non-roakienrial - -
Fxfsting use of
bulidktg a pr(:gmrty - SUB-TOTAL
I' utfe of �f jj *U OJIMMARM --
- TOTAL
NOTICE - -
TMs pim., beoomoo mi(l arvJ vok1M weak of oanhuction eutN".tod i•not cone
rnanoed wkMn 190 ctaysof M oondnx*km or worn is euspew;ed nr abandoned for " -
a psrbrl of 190 days at any 41me ehar work Is nonwranr rt
"CIAL OOOKXTYJM -- ---- -
Do% lestnekt - by