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13081 SW LAURMONT DRIVE 13081 SW LAURM NT DRIVE I N A 41 O 1i ro a I , 3 r� JQ �`yi. 4� ih ,t ►.�+�4 �. J�,�y���rtn i q r� 1„'�.,,ppv ` , yr 4� �./s , ��M�f � ! � � U w l i �wh t•'t t c��y r/��t, ,. w W� �",,��t,��` Y .ta'.' f R I/ t`�r'�i'! '7fit•`''1{� ... �l �jt :i,tt rrh�1�' �/le ti.�F� t t � JR � }t• ;ti � "' ' = ► �,.A1.Al�"1,� yi�a � t i. -fly .�: r• � I' iii �.ty! i C= 7CO 411 . rrn yA i l L'� it co fh cc r fa H q (� tE E CA ro V w �, do t m A w +'5 V P'A0 V) ►'� u� too c� [ p, N •r+ Jrm �. •� ' + N O N in M 1 ,� h0 ' ,,ka. ,, u n a a l tt 1 XV (fi d �i 0 D4 .. .,w .O {� ..N~., �,•�1 t - ,l! 41 V 0y) F" i y�y;? l l,' Hip b O ~ t ,ark a 9th ' .xA*T ,l AA ;I s� s� sew s sse s � ass INSPECTION NOTICE City of Tigard Building Department P O. Box 23397 Tiq,4rd. Oregon 97223 Phone 639 4175 Type of Inspection Date Requested Time A.M. P.M. Address L� ---L.-tld ='�` �-- Permit # � Owner— �- �:- Lot # _— Builder_The following Building Code deficiencies are required to be corrected: ------------------- Presented to ' �} pproved Inspector Disapproved Date CALL FOR REINSI'^CTION ❑ yet 0 NO INSPECTION NOTICE City of Tigard Building Department ,1 P.O. Box 23397 G Tigard, Oregon 97223 Phone: 639-41/75 Type of Inspection - L--' - ----.__.__---- Date Requested r:;) �/ Time_�_ A.M. P.M. Address _L�1 C I �� U_�C(V`?'t Permit *-S 4 Owner nn nn --�— Lot #_ Builder ---- 'i he folio-sing Building Code deficiencies are required to be corrected: Presented to _-- __ ,r'f Approved Inspector - -- ^ � � �_� Disapproved A-- Dote -- -- CALL FOR REINSPECTION ❑ YES ❑ No INSPECTION NOTICE G.ty r,; Tigard Building Department P.O. Box 2.3397 Tigard. Oregon 972.23 Phone: 639-4175 J� Type of Inspection Date Requested `�, ,/,_ __,_ r_�'I !(�T�i:na—__—_ A.M.._._.__r P.M. /'►��'� Addre s j J A., Permit Permit Ownf r — --— ti � __._ Lot Buildt 'The folly wing Building Code deficiencies are required to be corrected: i i f Presented to -� [ AfJm`oved R Inspector ❑ Disapproved Date CALL FOR REINSPECTION F] YES (_] NO air � aaR 'w aiw � .sn aav � we INSPECTION NOTICE City of Tigard Building Department t P.O Box 23397 Tigard, Oregon 97223 Phone: 639-4175 % f Type of Inspection Date Requested �- me._..-,_— A.M. P.M. Address l.c__ I Per-nit �h Owner ( ' _ CC l-liliti"Ylff,rl? ►.�!L� Lot #T4_ Builder The following Building Code deficiencies are required to be corrected: ice r Presented to Approved Inspecto.// r 'r`ti —__ 4-0 PProved Date —` CALL FOR REINSPECTION ❑ YE! ❑ NO INSPECTION NOTICE 2 . C) 01 City of Tigard Building Department F.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection C� at Date Requested Time-A.M. / SAV Address Pr -it Q_�3 Owner Lot Builder The following Buildina Code deficiencies are required to be corrected: Presented to 0- Approved Inspector LIDisapproved Date CALL FOR REINSPECTION DYES 0, No E3f.lILDJ:NC PF::f41411' CITY OF TIFA RD ��� I'1eRih12 r NC1. : h3lJf3'70;i;J�6 TC a nGAfm COMMUNITY DEVELOPMENT DEPARTMENT °"°°" UATE 'L`►fit 11:tS . 1, 88 13125 S W Hall Blvd.,P O box 2339r Tigard,Oregon 97223.(503)639-4115 i:)P x M. Pm'r .. NO 0,703.56 --- - og 0. p�-7 101:1 A00PES S : 1.X01 4 SW L.AL.IWMON r UP �'" 37 v 3 3'1 11,1'.41 r•IAfJ%I (T] 11 ,0 i,SO.; 38400 !.,I IH VILLAGE A', Sit IMMFi:FyLAKE: I. r •.,49 HK 1.-AND i.ISE ; AILIIPO I fl'f M I.)1. VALA1101 1.CIN 111 Ah ,000 5ki,1+1AC:K5r FRiUNT : 20 RALAW : :1 WORK C:t...ASS , NEW OWEL..L .UNITS : I I...EFT : ai? ATUH'T' : 36 I F-111 . 1 ,141r:, 5;7 Nt:;l...0 1 1AfHT1..'i NO G1F;.'gl?OOMS : 1:0NS T . '1'YI-''E. VN NO,BATHS : N: S : i:::: W (':T.w P3 i:1FIOT C1f�1:;P1:LNC:S C:1C:C.;up t.oAG1 N: S : E: W: T OTAL_ 1ARIF'A 1 -108 NO 15rOP IES . 1, 1ST : 1.4013 ROOF C;ONGT : C: FIRE PET7 I(':I I I 1 A r14u /11+14 6 5F.PA14 D A-1 I::1:1 HASk ME N 177 3R0 . C)CC:f.w .. SEPAR7 RA T M.0 r:L.00R 1._OAU : 40 U.ARAGF- 4.10 PIPE SR)PKI-.R'7 ALARM? 1''1..C)W 1 C PH) DE f LC:1'7 YES I-I AT• TYPE. : (::AS HDCP . AC:CESS 7 (0AR7 Ili 1141 (-:I IU.C:K BY : 1•.1 A. f2M,Ml•AHW 5 Mr..l;SY.11k: 01-0 No 6S106 LAST PET 551-11E M(. PttT GC.T,rlt;: MA4 i°t.)lM.f l' 11112,31 00 N I,e1 MIX 'I 95Pel 111 ,'11.1 PEA)I t::W 113 , E pr.1r•tIa1.1.1c1 rrr "i 1 F T11IE: DIF,PT R 111 11]1,.11. ("10:3) Pell 1,1l 1: I AX 1M 1.Ei 5.15 r.)If F IH P --" I)f;;:VC.1..C,)f')MI .N'T' rl•IAF1t::F::f; C 0 M0Rr.G111 VIE DON SDC;STORM) 11f'"' 3 . 00 N I: 11:1M x•11:111:+f lh%ll� T' I I�i. 01.1"1.1...DEJ:15i JN(-, ti 0C,( S'T REC:1 00 T PO PDX 1.+i+3r. A R)f1(,t 1 ) 1111250 . 00 A 1.:131 i 'l a111r1 1:11 >''%'I PFIFP A1.0 T I:'JFICINF 1'Sp:.K) E?44 5+:31,4 •' T O 1,4:1;1 5i'C 1"01 11IN NO .3101".13-'5 T fITAl. *I , ,46a, !•A R j This permit is issued subject to the regulations contained in Title 14 - of the TMC, State of Oregon Specialty Codes,zoning regulations FIE(4111(44L 1 'L'Nf'J1,71F ;T TDNS and all other applicable codes and ordinances, and It is hereby I-0(:)T I NI:: SKWU44 agreed that the work will be done In accordance with the plans and specifica+Ions and in compliance with all applicable codes and F'L)l JNOA r LIJN WALL RAIN DRAINS ordinances The issuance of this permit does not waive restrictive Prll l K tilm"AM W0*T f, P L,7.NU: covenants. Contractor and subcontractors shall have current city PLO, CINDERISL..1AS Cx r Y APPR(:'1.1/Ci W business tax permits This permit will expire and become null and L)L.,6D F 1-NAl. void if work is riot started within 180 days,or If work is suspended or 1,01:1111111 abandoned for a period of 180 days any time after work has M 1.H 1 1Jf.; commenced It shall be the responsibility of the permittee to assure I I Il111 all require inspections are requested and approved 11.1",M I. TW - I tial It A r:G1,)N Pei Issued By — - 1:• . :I V TON - SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE CA ok- CITY OF T167A RD !iEUEA Plil...*141MI 1* ClT4§LRD E PM IT NO. i SE870339 011100" COMMUNITY DEVELOPMENT DEPARTMENT C�4( 13125 S.W.Hall Blvd..P.O.Box 23397,Tigard.Oregon 97223,(503)639AI75 DA*71.' 7Sj$LJVA I I P.6 I as P PRIM. PM I F10 Ell r 0 33 6 J08 AIJOUPI ,SS : 1:3O" SW L.AtJRM(:)N T' UP USA NUMBER 34923 'I AX 1150. '331JC, 1W400 �Altj: VIA I AGE. A'I FiLIMMER11 AKE L'T : ;39 PK LANK USE: 1-01 1151ZE. : !ii EC;y*1ON: 33 I'WP: 1.111 RNG; 1w WORK ("A.0S. S ! NEW I.PiE TYPNE: SINGLE FAMII .Y f 141:)111:1.:1 c::m.n t. 4091-e*110 t With 41113 1-1.11vilitl 11111d limiwer-ago Agetic!y . 'The Permit expirem I.VO days -Fr•rim the dukto imist.ied . The t(.)toLl oncit.1111. 1:)1nicl wJ1.1 boo I -F the per'InJI, 4i.-XI:)JI,"1n . The c1clein licil, ntl—t(mv the af thirit of thO f8i(1611 (6T?W*7f-- bill,tVI"40:111111 . T-F 010 100W011" iM 111: 1, 0-1. 1,110.:il giverl , t'hove :1.Olin tINI "I fipl- !111-1141.1 I'll I&).). dirnertlonio -Frain the distance given . 1-F not ma :Lac�alted , the irintaller inhaL11 Po1-1111t li'll-10 111-1er. 0(4*)J-J4.-9 W:11.:1 :'LJJJ`.iJ1JIJ.'[1 OR INSTALL- TYPE : E.A.111-01:NC." 511:-WER IMPEAVIOUS APEA: I 1XILIPF 1.11W."irs : Il Nwl 1WIPOVEMEWT : DWELA.ANG UNITS : 1. NO 011- 0 F*:Es : W MCI PT xi S L I I C: DON PF-1.4m]''T $35 00 N E PC BOX 1y.52-1 CC)NiR.-*.'.CT1Ol`41 C'.1--lARGEE $1. 11.00 . 00 P ri r,1A.at I I d ci 1-, 97 P.I.1? IAP INS'lAI.A. PHONE (303) PAA 931.41 f"ITI-11UP 1111,360 , 00 C 0 N MC)p 1:ro SETTE: DON T R OCIN 1`1101:41CISA: I' ll:K DUDFA, TL ,!:, It)' C A PC "OX 195e4 T 1-11-11,1-1 M I I cl cii, 91PI.9 0 PIAC)NE: 11503) VA-41-931-1 I CIIIAL. "I 1. /119 1111 . CI 0 This permit is issued subject to the regulations contained In Title 14 PECEAPT NO g C85/ of the TMC, State of Oregon Specialty Codes,zoning regulations and all other applicable codes and ordinances, and it is hereby 1:11F.I(AWERED TNSPECIJONS agreed that the work will be done In accordance with the plans and specifications and in compliance .with all applicable codes and POLI(A.-I-1.N ordinances The Issuance of this permit does not waive restrictive covenants Contractor and subcontractors shall howt. 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 all required inspections are roque ed and approved. Permittee S nature Issued By: FOP TNISPECI"TON 6,39-4175 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE PlAJIMEA"INIC; CITY OF T IGA Ra �CC4"YOF�TWA�10 PEPMIT NO . : Fit 070337 COMMUNITY DEVELOPMENT DEPARTMENT MOON 13 125 S.W.Hall Blvd..P.O.Box 23397,Tigard,Oregon 97223,(503)6394175 U111-ILK 1551.111%-U : 1. 68 FJ 1-4 L M PM T NO El 70,536 JOW ADDAE-."Gs : 140(;10-514 LAUPMON'T DR TAX MAP111 CIT .1.45:11. 33E)C. lcvloo 51.lr.3 : VIL.L.A.-C3F.' Al' 51AMM1:;:Pl-,.AKE I T :39 RK; LAND USE : LUF F51ZF.-: : XTEM: NO: NO: W(')r1K CLASS : Nl;.:W WA'11 ER CLOSET I pAli", U51r.: TYPE: S3:N(.v'LE FAMILY UR1NAL. 101107LOW PPVN'T'R CONST TYPE - VN L AVOPAITsPy P. TPAV, PD1M1:::P 0(','Ct 1P . GRP . TUS SHOWER k! CVr-41.;::ASE TRAPS D1511-1WASHUP J. GAPBIAGA" NO . ti'f 0 V41 E S W0 514119C; MACHINE L DWELL .UNITS : I L.AUNDRY 'TRAY UL.DG DRAIN (DIA F I DOP L)FIAIIN 51 N k WAI'F-11 HCATI-J-4 OTHER I I:MAPKS ! F'F.;'ES W N 1*10 P 3.FiS F:1 11'K D0114 L'.1:�M.1 11' E Pa BOX 11.93FA R r.)a i,t: n ri d 1:71' 97'r',19 1 1.X 11.1 R EF.S PHONE (!50*,'3) i,!.eI-eI.-931.d1 STATE TAX 0,111 U-1:P C G N S T .11-10EMAKER HAPOLD R SHOLMOKU.P' !�- 1:1-UMHING IS A PC BOX E250 7 *3 V1 t fit t::in d n n 1 9 7 0 PJ5 0 PHONE (501) 630 7 7 V F3 R 1:411iKCIS'114013 UN NU 39PP. 01,111 1.P.3 This permit is issued subject to the regulations contained in Title 14 PECK'T.PT NO . of the TMC, State of Coon Specialty Codes,zoning regulations ........ .................. S and all other applicable codes and ordinances, and It is hereby PEQUIPED INS!'ECTUINS agreed that the work will be done in accorda,ice with the plans and 1j)1.-H 1.11NDEPtil-AS specifications and in compliance with all applicable codes and ordinances The issuance of this permit does not waive restrictive r*,(:)s*r & BEAM covenants Contractor and subcontractors shall have current city WOT11134 LINE business tax permits. This permit will expire and become null and 1-4-8. I'LIP111"UT void if work Is not started within 180 days,or It work is suspended or PAIN DNA INS abandoned for a period of 180 days any ,.me after work has commenced. It shall be the responsibility of the permittee to assure FINAL all required ;ppctions are requested Find approved. P Permittee Signature Issued By q�� N%F7I;-i*C-1 T.ON 6,119—A SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE WAN. --- -- Mh:GHAN 1:CAL. PEIC+t41:.r CITY OF TIGA RD I�ERM:r T' N(] Mlr.tl7Q:3w1k1 uTrMeow I�A•rr�: 1.SSLIE:Doc n6Atm COMMUNITY DEVELOPMENT DEPARTMENT 13125 S.W.Hell Blvd.,P.O.Box 23397,Tigard,Omgon 97223.(503)639-4175 ✓� PRIM . PMT' NO . 0,10336 JOS ADDRESS 1-, 00" 'a"W LAUPMON'T' OR 1A MAP/1-01* 7.511. '33 Dc' 5.".00 S;UD: V11-1-AGEi: A•T S;I.IMME:AL.AKE: I...AND USE:: I O'l' S:C"L.F.: NO: NO I'T'Ei:M ; WNW CI..,AS;S : ll F 34NACE. (1,00K i A1'n HANDI...W (1-0 RISE: TYPE: SINGI-Ei: FAMIL,.Y F:'I.1RNACF. 100K•1• AIR HANDL..R 101( C,'JNS'I• '1'Yl::rl:i: : VN I'l-001'') F t.1RNl1C;iii: E»VAKy C:OOL..E:R OCCUP GRP. 173 HE:A'1'C'.FI VEN'T FAN VL-N 1 VE:N I' SY51'E:M I-,hJ.iI/CX)MP ( 311P HOOD 1. NO . s'C'ann.,:S; : :I 01-F2/L;OM6a , :I.�1FII•-1 INC::I:tJE'R�1'Tt7F2(DOM Ul TS : 1, 14I...R/COMP 1.5•••1:30HP I NCI llPAT on(com ! 11U.,L. TYTar»: GA5 111-PlIGOMP ;30•-C R., PEKPA:I:R (.)N:I: TEi MAX . :I:NPt.l'T BL.R/COMP no-14'll, OTHER F"1611::: I)MPPI-i! (:vA£i PIPING OLITI...CT'S i. HIGH PPESS? I Ow PI-1117.:`411157 O M(:IR:C!:,Sfw t"T'h% U(.)N f;l'PMI ll1111.I.0 . O() W I)0 nQX 19".12/1 6N PI:-0.11:::W Ak ) La N r M1.H . 51O E I:tor•t,:harlcl or, 97219 FIX111RE.S R PHONE' (,503) 2/14 9*41.1 51(YTE I AX 111 1. 13 tl T'F4k:{'1 _ C O N E3E:1.1.. Hr"A'T':r it :I'NC . T R 1.55.505iE:: PIAZZA AVE:: A �,,1 .�r. It w In 0114 n r- 97 01.3 C Ia1IrlPdl::: (503) 2-141-•11,N4 O I ', ! 130'1'1:C)N NO n4f 101 Al- : Al 37 . 0)5 C. PF.CE I P T' NO. ,,This permit is issued subject to the regulations contained In Title 14 of the TMC, State of Oregon Specialty Codes,zoning regulations PiEQU I RE D INSPEi C-TI ONS and all other applicable codes and ordinances, and it is hereby t.;AS L. NE' agreed that the work will be done in accordance with the plans and POST t3 E)E:'AM specifications and In compliance wit''1 all applicable codes and 11011.11011-1 1 N ordinances. The issuance of this permit does not waive restrictive covenants. Contractor and subcontractors shall have current city r=INAt. 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 dans any time after work has commenced It shall be the responsibility of the permittee to assure all required n,spections are requested and approved. t Perrnittee Signature n� I � f X11 Issued By \ -- 41 75 SEPARATE 'PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE '3 9Z ti 14 CITYOFTIVARD 0FTl6'4RD PLAN CHECK APPLICATION CfiY / COMMUNITY DEVELOPMENT DEPARTMENT oeeoow PLAN CHECK # /2. 2 13+25 SW HdI abd P.O.am 23307,Tip id,awm vrm(503)M4175 PERMIT # g7o �. DATE ISSUED JOB ADDRESS: _ '� Q_ 5 W •L AU t7 �MM1 T �(� TAX MAP/LOT /j SUB: U LLI s�mr►��L.wIcQ fAa LOT: �1 LAND USE: Z P VALUATION: �� G'i'...> SETBACKS: FRONT: ate_ R.EAR: ! LEFT: t RIGHT: 4- WORK WORK CLASS: HEIGHT: TOTAL AREA: 1'J Ub USE TYPE: FLOOR LOAD: IST: CONSTR TYPE: HEAT TYPE: ,�,�:,� 2ND: OCCUP GROUP: — DWELL/UNITS: 3RD: OCCUP LOAD: NO BEDROOMS:_ BASEMENT: NO STORIES: �_ NO BATHS: 2_ GARAGE: IMP SURFACE: APPROVALS REQ'D SPECIAL NOTES ITEMS REQUIRED PLANNING: REISSUE OF: 96 LIST SUBCONTRACTORS: ENGINEERING: LAST REISSUE: BUS TAX: FIRE DEPT. : _ FLOOD PLAIN/ CALCULATIONS: OTHER: _ SEN LND.: TRUSS DETAILS. PARKING PLAN: LANDSCAPE PLAN: PLAN CHECK BY: OTHER: COMMENTS: ACCT I DESCRIPTION AMOUNT OWNER 10-432 Building Permit Fees N MfE: Dnw M! C'EL _ 10-431-600 Plumbing Permit Fees ADDR �Z10-431-601 Mechanic.-/.I Permit Fees T1 Va, 01 c 1�_ 10-230-501 State Building Tax (5%) 0.111- 10-433 ,yL10-433 Plans Check .Fee ' y 7, lZ PHONE: 2 4 sl 30-443 Sewer Connection (20x) , 30-202 Sewer Connection (80X) 'q h.,0 p � CONTRACTOR 30-444 Sewer Inspection NAME: .51-448 Street System Dev. Charge (SDC) ADDRESS: '52-449--610 Parks I System Dev. Charge (PDC) S ?S u. 52-449-620 Parks 11 System Dev. Charge (PDC) 3 — 31-450 Storm Drainage Syst Dev Chrg(SSDC) S 3 S U. v i PHONE: 10-230-505 TRFD (95x) M 10-435 TRFD (5%) ARCH/ENGINEER 10-230-506 Washington County Fire #1 (95X) NAME: - _ 10-435 Washington Country Fire 11 (5%) ADDRESS:_ 10-220 Amarr/Wedgewood TOTAL �_ '`a Io , PHONE: 17 G 3 3 ' PREPAID 3Pw ft? 3q r3-,a�1 r L BALANCE DUE1,30 D,,', _ APPL ANT SIGNATURE / /Ga 47 Received By: ` �6 Date Received: w w ti w M M M w" I it I c. CITYOFTIGARD � PLAN CHECK APPLICAT CtTYOFTLARD PLAN CHECK COMMUNITY DEVELOPMENT DEPARTMENT olmooN 13125 SW HMI Blvd P.O.Bat 23397,Tlp W,Oregnn 9=(M)SM4176 PERMIT DATE ISSUED_ JOB ADDRESS: " 1n n� TAX L T 0 S `a �,,, L a U t�-i' u T A MAP/LOT SUB: llACn(3141 SQr, i (.i)K.X LOT: LAND USE: VALUATION: -2tt3vd _�' .-moo VV-1- SETBACKS: FRONT: REAR: � LEFT: RIGHT: WORK CLASS: , ,,.. HEIGHT: ti O TOTAL AREA: USE TYPE: Si FLOOR LOAD: 1ST: CONSTR TYPE: HEAT TYPE: 2ND: OCCUP GROUP: DWELL/UNITS: 3RD: _ OCCUP LOAD: NO BEDROOMS:__ hASEMENT: NO STORIES: — NO BATHS: GARAGE: IMP SURFACE: APPROVALS REQ'D SPECIAL NOTES ITEMS REQUIRED PLANNING: _ REISSUE OF: LIST SUBCONTRACTORS: ENGINEERING: LAST REISSUE: BUS TAX: _ FIRE DEPT. : FLOOD PLAIN/ CALCULATIONS: OTHER: _ SEN LND.: TRUSS DETAILS: PARKING PLAN: LANDSCAPE PLAN: PLAN CHECK BY: 7 `- OTHER: _6 �J COMMENTS: ;7-,- •�•<r - _ .� i ACCT f DESCRIPTION AMOUNT OWNER ].0-432 Building Permit Fees 3 y NAME: rJ 11'IOR ISS S 10-431-600 Plumbing Permit Fees ADDRESS: 0 - 2 10-•431-601 Mechanical Permit Fees � k2 IL_ p 10-230-501 State Building Tax (5X) t .c 0/_ 10-4.33 Plans Check Fee PHONE: - <4r 30-443 Sewer Connection (20X) 30-202 Sewer Connection (80x) 3 r? �• CONTRACTOR 30-444 Sewer Inspection NAME: .51-448 Street System Dev. Charge (SDC) $ (, o ADDRESS: - 52-449-610 Parks I System Dev. Charge (PDC) 1 St.� 52-449-620 Parks II System Dev. Charge (PDC) $ �. 31-450 Storm Drainhge. Syst Dev Chrg(SSDC) PHONE: 10-230-505 TRFD (95X) 10-435 TRFD (5%) 4 ARCH/ENGINEER 10-230-506 Washington County Fire #1 (95X) s NAME: 10-435 Washington County Fire #1 (5X) ADDRESS: 10-220 Amart/Wedgewood ^�z,._ L2 Tom PHONE:_ PREPAID y � REC }' BALANCE DUE $ -34a- APPLICAN GNATU \cived By: jj�� Date Received: I i, L i d C 7