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i:\records\microtlm\targets\building.doc
INSPECTION NOTICE
City of Tigard Building Department oo
13125 BN Ball. Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 6 9- 1
Inspections _
Footing Plbg. Underslab Hoch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out as LL* FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Pont/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor w ter ine Gyp. Bd. -Hech.
Data Requested: Times AN PH
Address (D U �C a//rmit i/s{�}� cGp93p� O o sQ
Builder:
THE FOLLOWING WRRECTIONB ARE REQUIREDt
Inspector• Date:__JJ/
_APPROVED —_ DISAPPROVED —_ APPROVED SUBJECT TO ABvvE
__Call For Reinsp.
M
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
'3125 SW Hall Blvd.Tigard,Oregon 97223.8189 (503)638-4171
7
1
AV
C".I T PT M- PAymr-,NT I PT NO. -93--038397
CHECK AMOUNT s 1-119. 00
NAME MUTMANTUll CASH AMOUNT
(;Dr)REF-;S 7721 SW CIRRUS 17k VF PAYMF-'NI DATE 03/31A/S3
C IVISION
sr,AVER-rON, OR Stiso
9 7 Q'105-
v',URr,oSF-. OF PAYMENT AMOUNT POIL) PLIRPMA: OF PAYMF:NT AMOUNT PAID
-------------
r S 1 50
MECHANICAL F+ W.C93-0040 30. 00 ST. AULD PER
F-,LAN CHECV, Fl- 7. 50
J6;7'-'Q710 SW POGIF'SC, HWy-
I0-TAL. AMMINT PAID 00
\ "M•.v'p"c- yy .,,.,rte 'hu. � 'Y- Y.u.} 't"�"+i°0. .1 ""� b �Ms���;:r
r
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• 7
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M///"� Z � ��a�.yy1 0 �• ,mow a
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1
INSPECTION NOTICE -S�U,•��s�s
City of Tigard Building Department
P.O. Box 23397
i
�+ Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
G c�
Date Reqvested 4�— `� �`' �' Time A.M. u P.M.
Address�� `__�L� S w � A� _• i � Permit #R P'2 X7,,,3
Owner__. _ Lot #
Builder
The following Building Code deficiencies are required t') be corracted:
," ..— ,c A FU TD j4-7 d
--
Presented to _ ,.v ❑ Approved
Insperty, � A4:)isappro,!ed
Date
CALLFOR REINSPF;CTION
❑ YES 0 NO
MECHANICAL DE'lPIMIT
CITY OF TIGA4RD 'M4, V"EPMIT NO. : ME-8eP-0-1.15
CITYOFTWAV I
COMMUNITY DEVELOPMENT DEPARTMENT DATE 15E)LIED : 10/ 18/88
13125 S.W.Hall Blvd.,P.O.Box 23397,Tigard,Oregon 97223.(503)6394175
00
A* R ADOPEKSS : J.6e-2SW HWY s
T'AX MAP/1-01, EiUH: 'TIGARD TOWNE ciQUAPE L"I BK :
I.-AND USE :
1-01i SIZE.':
iTEM: NO: NP
WORK CLASS : AL.TE.PATION POPNAGEE <11.00K AIR 11-11ANDI P <10
USE: TYPE : C.OMME*r&.IAL FURNACE 100K+ ATR HAND'..P 1.0K
GUNN-T . TYPE: 3:11N F LOOR F*t.)nNA(:,F:.: EVAP. 1:.0011-EP
OCCUP .upp . : Be HEA'T'ER Vl-.'N*T FAN
V E--N'T VEN'T . SYSTEM
131 P/G0M1*-' <31.4p HOOD
NO- L,")TOPIES : 1 81 P/It'.101,11P 3 :1.51-1P IN(*.3NEPAT[)P(DOM
DWELL. .IJNi lrS : FjLP/COMl::, 15-30HFI INC,*LNERATOR(COM
1::*UE:L- TYPE GAS l3I..P/(:,0MP PI:J:'AIr4 UNITS
MAX . ilsipu'r 8 1 II/It"'UMP 1110-14il-I OTHEP
r .T.REa IIMPPSI? 1"!0 G(-%S PTPING: OUTLEY"i
HIGH 1:'8E"5157 NO
LOW PPF- Gl? YEG
1:41EMARKS :
1(orivirit Mcid : Sidriey
FEES :
0
W T PERM] $1.0 . 00
N Fit AN IIEVIEW 109.25
E
R P7 . 0
STATE: TAX it;1. .8.5
OTHER
C
0 Rc.wi-F.,Y DON
N
T 0 E.W I E'Y MIELIHANIUAL
R P(*.)Box t661.
A
C Daavfmr•tml-1 OR 9'7001nl
TO PHONE*.: ( !'50 3) 6H6---8986
PEGISTPATION NO. 80W'I.t.iy T(ITAL. : *At.*). 10
AECE 3:PT NO .
This permit is issued subject to the regulations contained in I itle 14
of the TMC, State of Oregon Specialty Codes,zoning regulations
and all other applicable codes and ordinances, and It is hereby Pki--QUIRED 'I:NSPE(';'TA:ONF5
agreed that the work will be done in accordance with the plans and (*,,AS LINK.
specifications and in compliance with all applicable codes and MP.*(',1-4AN(,L- . SYSTEM
ordinances. The Issuance of this permit does not waive restrictive Fl.NAI
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 an) time after work has
commenced It %hall be the responsibility of the permittee to assure
all required inspections are requested and approved.
-e
P a
4t I Ignatum'
'7&t)issued By:
Al. 5
SEPARATE PERMITS REQUIRED FOR WORK JITHER THAM DESCRIBED ABOVE
LA I Y Ut- I IUAKU MEGHANIGAL PERMIT
Perinit #t �•�___
IQ G ( Description
( O Table 3A Mechanical Code CITYPRICE AMT
131255 SW F tall Blvd.
City Tigard ZOv3 1) Permit Fee -0_ -0- 10.00
P.O. Box 23397
Tigard, OR 977.23 2o7 '-, 2) Supplemental Permit 3.00
639-4175 1) Furnace to 100,000 BTU 6.00
incl.ducts&vents
2) Furnace 100,000 BTU i 7.50
incl.ducts&vents
Name of Development 3,r Floor Furnace 6.00
GA Le 5 _6. _ incl.vent
Job Address /� ,/ 4) Suspended heater,wall hoater 6.00
Address �r0 5x f&_4 PC, HGu ve or floor mounted heater
Tax Lot Map No. Vent not incl,in
Lot Block Subdivision 5) appliance permit 3.00
Name(or name of business) 6) Repair of heating,ref r lg., 6.00
f cooling,absorption unit
Boiler or compto 3 HP
Mailing Address ;7ne 7) 6.00
Owner / 26c5 Gtr V absorp.unit to 100,000 BTU
City/Slate Zip 8) Boiler or comp to 3 HP-15 HP 11,00
I,G44n absorp.unit to 500,000 BTU
Name 9) Boiler or comp 15-30 HP 15.00
'S absorp,unit 1/2.1 million
Meiling Address Phone 10) Boiler or comp to 30-50 HP 22,50
absorp.unit 1-1.75 million
'77 21 �cv G°12/�t:JS 415-:,26,5 9S� p'
Contractor city/,QtateBoiler or compto 50 HP 31.50
riN �700s t1) absorp.unit 1,750,000 BTU
Stale Registration Nr. City Bus.Tax No. 12) Air handling unit to 4.50
10,000 CFM
1 herebyacknow Air handling unit
ledge that I have read this application that the information given Is 13) 10,000 CF+M + 7.50
correct,that I am the owner or authorized agent of the owner,that plans submitted are in
compliance with State laws,that I am registered with the State Builders'Board,that the 14 Non portable
number given is correct.(If exempt from State registration please give reason below). ) evaporate cooler 4.50
C
15) Vent fan connected 3.00 //yy,,
— to a single duct 3r W
--- — ' -- -- 16) Ventilation system not 4.50
Included in appiiance permit
- ----- 17) Hood served by 4.50
v mechanical exhaust
Signature er or agent) Uar• ) domestic type n
Describe work p addition P. alteration 0 repair Fl B Incinerator 7.50
to be done residential p non-residential F-1— 19) Commercial or industrial 30.00
Existinq use of -7-7 _ type incinerator
building cr nroperly k t TX C 4, S lDA:5 ) Other i.e.,woodstove,water
Proposed,ise of
20 heater,solar,clothes dryers,etc. 4,50
buildinq o,, property _-- 21) rias piping ine to four outlets Z 2.00
Type of fuel- oil (] natural gas LPG ❑ electric
22) More than 4-per outlet
NOTICE SUB-TOTAL 370
THIS PERMIT BECOMES NULL AND VOID IF WORK OR COA- - —
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 So-JO 406 SURCHARGE
DAYS, Ur" IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL 9.2.5
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER l -- -
WORK IS COMMENCED. TOTAL _ W/O
Special Conditions
c4..!='�—•------ --.�� � - -�---- Date issued _ _ by
PEPM:E'r
C''�OFTIVARD I._1I.'_PH1'T'PLUMBING NO. : PIL80207A
CITY01IFTWARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 S.W.Hall Blvd,P.O.Box 23397,Tigard,Oregon 97223,(503!4'IQ-4175 D A 11:;,. T.9)!..-)(ill-K 1") .1.0/.1.F)/08
FRIOP-Wica-
.1014 AIMPE-55 : 16200 5W I"-1A(,'TF1C HWY
f*AX MAP/L.(:11* GUH: )JE APE) 'TOWNE SQUAW- L'T : IRK :
LAND USE:
LOT 51ZE :
T NO: Ni i
WOPK U.-ASS: ALTEPAIJON WAIIA C11 0 S E T I TRAP
USE 'T'YPEK: '.-JIMMEACTAL. URINAL. BKF-'*I-(:)W PI;IVN'T'P
DONS T . I*YF"F.::: 11IN LAVORATORY I TPAP PPIMEP
0111'CUP.GlIp. 82 TUB 15HOWE1=t I'PAPS
1)1 SH W A 5HE R
0T*SPO50-L.
140 . STO P T E 5 :1. WAFA-13'
N(.; MACHINE
DWEL.I... .UNI*rs : LAUNDRY 'TRAY BL.13(3. I)PA".I.N ( I)J'A
FL.00P Dl--4A:I:N
SINK SEWED IF T' )
WAI'E.R FIEA1*E'P t S'TOPM/PAIN (FA
L OTHEI14
MAN
,rc,riaLiit MIA ; Gich-tey ' a
0
W Weti;tL,)(30(1 T
N
E
R FIXTURES
STATE, TAX $1. .X10
0144FA $7 . 150
C
0
N
T MILWAUKIE P1 11.11"IBING
R
A Pa EKIIX 593
C 97 0:1.5
T
0 PHON11": (503) 6555 9t61.
R I PE13I.S1411ATION NO. 500'e? TUT'All 039. 00
This permit Is Issued subject to the iegulations contained in Title 14 RF.X'E:I1'-Xt NO . /0//4/3
of the TMC, State of Oregon Specialty Codes,zoning regulations .......
and all other applicable codes and ordinances, and it is hereby 3.N!5PEC'T10NSi
agreed that the work will be done in arcordance with the plans and PLO .UNDEASLAB
specifications and In compliance with all applicable codes and FK)UGI+-JN
ordinances. The issuance of this permit does not waive restrictive
covenants Contractor and subcontractors shall have current cl,v
busin,-qs tax permits. This permit will expire and become null and F 'TNAI
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 0all be the responsibility of the permittee to assure
all required Inspections are requested and anproved,
Permittee Signature
Issued By: C.'AI.A. P'OP 'ENSPEUT111IN 639—el1*75
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
P.O.lbx 23397
CITY OF TIGARD PLUMBING L-31125 cW tau L-11%;
Appkinh, must hold Oregon Registration to coodud alombin r Tic�3 CR 5772.3
/business or must be property ownedoperaux not hiring mitsick help B PERMI f 63-4-4175
Name of Development r 7 7 q
Plumbing Permit No. w
Address _ Description
ORS 814-21.010 DUAN, PRICE AMT
Job Tax Lot Map.No. T-A ---
Address
FIXTURES _
1_04 Block Subdivision -- -- -_--- -
Sink 7.50
Name or name of business) Lavatory - -- -- _ 1 7.50 7"
`j,61,,)x.4 � Tub or TubrShower Comb. 7.50
Via rung Address
Stxywor Only 7.50
Owner City/ tate Zip Water Closet - - 7.50 SD
Dishwasher 7.50
Garbage Disposal - _ 7.50 _
-- Name Washing Machine 7 50
Cay -
fimr Drain 7.50
Mailing Address u Phone _ Water Healer 7.50
-- Laundry Room Tray 7.50
Occupant City/State Zip --
Urinal _ 7.50
---- T ate_--- -�� Other Fixtures(Specify) - 7.50 `
7.50
Mailing A4kiress Phone - 7.50
Contractor City/State ZIP - _ 7'50
MISCELLANEOUS
City Bus. Tax No. Sower t st 100' _ _30.00
50�Z Savor-ea.Addit.100' 15.00 -
tale -tloar3 Flo- tele rs s. o.
Res tial) _I Water Service 1st 100' 20.E
I hrxeby acknowkOr that I have read this app4catbn,that the k,lcxmatlon Water Servioe ea.Addil.2001 15.00
9rven is coned,that 1 am rogislered with the State Builder's Board.and also Sit 3 Rain Drain 1 St.100' 30.00 -
have a SLsla Plumt*)g 6cortse that the rxxnhers given ars correct.thtal all
piunking work wiU be dom xt acrordarr_e with apptic-bte Vcvisbns of Oro. Storm b W:Jn Drain Addii.100' ,-15.00
goo Revised Statutes Chaplors 447 and 693 w-ki eppllcabb codes arxh that Mobile Home Spero _ 25.00
no help will be empbyod unless licensed txidor 0,9S 693. In exempt from Back Flaw Prevention
Stale registration,please give reason bok�w).
NrWFr1WNERF-1 hwrr+tw rrrrtifv that I am IM owner Of the property do Device or Anti-PolkAion Device 7•50
wx-r a above,at which location I propoee to make a plurr> hnlallat.on kr Any Trap or Weallo Not
my own use and thin property is rr.N bektg ecxrstructed kx safe,tease OF rens C,<xv *od it)a Fixture - 7.50 -
Catch Basin 7.50
--- ---- - - -- ----- kap.of F-xhet.Plumbing 40.00 Por Hr. _
------ ------- -- ---- Specialty Req_eeted Inspections 40.00 Per Hr.
Alter.of Pkinbxsg wtttdn
_--- - an Existing Bldg. 15.00 min.
AUTHORIZED SIGNATURE �- `� Date New Bldg.or BuN.AddKlon 26.00 min.
F 1 Dain e famil'r
Descta)o wonew addition Q aitoratlon❑ re Qtr Q C�.1o1.1jIt3 15.00
rk
t2 be done residential nrxx�-reeidentiel -
CAsting Use of S(WTOTAL
tn)l{dfrl0 or property-_-- -- -__- - - --- -�
Mkta�URe o1 ------- k tUF1C11A1IdC / 5'U
t or qty-- - -------- ----- --
NOTICE
This pwtnk f-we rNs null aril void M work or oonet Uctwn s,Ahnrued is corn --77 Ta L
rrwncod wkhln 110 days Ar or workto*^--W or ebrxior-ed
a period of iM days d any fiche atter work u oort "v oad.
titnctm.00110(T10et9__-.� - -- ---- Date Jawed by -------
DING PERMIT
I-Ifi-711MIT NO. : BU8812073 V
CITY OF �'��RD ' t-�- "":"-
CiTYOFTWARD
(700-F- ARID
COMMUNITY DEVELOPMENT DEPARTMENT xr DATF.. ISSLAKILI: 10/1.7/Be
13125 S.W.Moll Blvd.,P.O.Box 23397.Tigard,Oregon 97223.(503)639-4175 [)PIM. PMT .NO. 882073
,JOB ADDRESS : 1.6POO 13W PA(. IFIC HWY S . Q
TAX MAP/1-01 SUB: tIGAP0 I'OWNE SQUARE I-T - SK
LAND IJSF-* : ev&
LOT SIZE: VALUATI.ON 3:3 ,000 SEI E)A(:,K 5
F'RONT ; 1:4-61-:
WORK (:'LAS15 : ALTERATION DWEL.L .UNITS : L..E:F'*T*: RICH
USE: 'T'YPE:: C'OMMERCIAL NO. BEDROOMS EXT WALL. CONST
C,'ON!!T . TYI---1E: 11:111N NO. BATHS : N S : I- W .
[J(:',CLJP.GPP . : U2 PROT .OPENINGS :
OCII'UP.I OAD 77 N S : I W:
I UTAL. A11EA : 2;340
NO. STORIES : 1, IST : 21,5410 POOF, CONS T, : A F"1:Wl-. RET"? YES
1--'F:I CHT : :1.8 ?NU: AREA SF-:P'-IAR'? YES WATED: NA
BASE-MENT7 NO ','SRO: O(;CUP. SI;-".PAP7 YES RATED:
MEZZANINr;:-.7 NO B A ti r--'M I'
IX I OOF LOAD 50 SP14I(LP? YE S ALARM'?
FLOW(GPM) Dl:::*T*E---CT ?
HEAT I'YPE: (.,A!5 H0(*1.I-'1,A(.(."E!:i'.i7 YE'S C,'OPR? NO
PLAN [HECK DY: Jhj
PI:KMAPIKS :
T 1imarvt, Mc)d Sichiv.,kl 1-41-ISSUE OF' NO.
LAST PEISSUFo '.
We.-,I Iii t,W c)(1(.1 FIERIMIT $206.50
VV
N PLAN REVIEW123
$ 3/1.
E DEPT $8H.60
STAI F.. TAX $1.0 -32
0I HER
G DEVELOPMENT C;HAPG11.S :
0 SD(:1 I STOPM)
N WETC-
SWOOD ORPOPO -1 LON S11CASTPEE t)
T
3030 45W MOODY PIN:,k
A 13 0 1''L:I.ak ti d L)r- 9 7 PREPAIII < $P-1 6.83)
C
T (503) K22---POOO
TOTAL : $216.82
0 1ON I '".) . 3339
RE(.3EIPT NO.
This permit is issued subject to the regulations contained in T itle 14 ..................
of the TMC. State of Oregon Specialty Codes,zoning regulations 1:4 E Q t J-r.P liZ 1)
and all other applicable codes and ordinances, and It is hereby F44AMING
agreed that the work will be done in accordance with the plans and
specifications and in compliance with all applicable codes and 3:ISIS IJI...ATI ON
ordinances. The issuance of this permit does not waive restrictive GYI` . I:,.:OAPD
covenants. Contractor and subcontractors shall have current city 151.1i PLNla CEILING
business tax permits. This permit will expire and become null And
void if work is not started within 180 days,or if work is suspehded 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,
Ail,—
P4ermltte Signature
Issued By: 114AI-11
SEPARATE PERMITS PEOUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
0(.111...D:rN(:•, PIEPM7:T
131.1(3t3r.''p7:5
IF- C-17YOFTIGARD Ct„ l1 PB.PM:r'T NO.
COMMUNITY DEVELOPMENT DEPARTMENT °MOtlN p/7
1:)A'1'E:: :I:SSIJw:D : /E3f:i
13125 S.W.Hell Blvd.,P.O.Box 23397,Tigard,Oregon 97223.(503)639-0175 P FI 1.M. V-1KF.NO . 13W p'7':S
..08 AD1: PEtjS : 1.6200 SW PIA- C7:FIC: FIWY
'TAX 11AP/l.„O'1' SiLM : 1JUARD TOWNE L'5QLJARl: I...1' : BK
11-AND (.1SFi.:
1_.01 F.-II•1.E: VAI...I.WYA.ON' $ 331000 SiEi:TBAC;KS
F PONT : PF:Ar; :
W(:)PK CI...AS5 : AL_'TE DATION DWF.:1...L. 1.1NTTS : LEFT : 171:1:(7,1-IT
1.1514: 'TYPIF: : C:OM111FOC::I:AL. NO. W.,J)HOOMS : I:X'T . WAL.L.. 1'ONtYF :
i.,ON51' . :I:T TN NO , HA'T'HS : N: Si : F' . W
OC:CI.IP C7rTl' . 132 PR T .OPEi.N:1:N(:d!ii :
0u:0.11:" .L..(:)AD 17 N: S : iii:: W
T(a TAI_ APPA : ! ala
NO . STOP:LKS : 1. :1.!:i T : e!:4,e.I POOF (:,(:INS'T : A F :r.PF-': RE.T'7 YES
i:?ND: Ar1F:A 511PAr1'7 Y .S riA•TE;:D: NB
Ii3ASI.ME':N'T'7 N(7 31:41:): ()(:Cl.Jl='. SiE..PAP? YF•!i
MI;:-tZAN1Nlii:'7 NO UASiF:M''T
I...OAD . :gip SPr11(L..P7 YIi:,S AI..APM'7
I'1.„QW((:d PM) DF: 1::,(-1"1
1 II"ft f l•YI:''I:':: ("v A0.i FIDt:,P .ACXA--:5%? YE:S (.;C)G1r1'7 NO
l."11 AN C:IIEi.C;K DY : jhJ
1111KMAPI(S :
Tiortatrlg, mucl : S i.y:lrtwty ' 91 r2li::CSiS LIE OF NO .
I'�E:E':!ii •
C',l:)r2(:)I•y(7r1F1i':f.t:)N PI:::PKI:T 41206.50
W :30:30 SiW MOODY 1•'1...AN riEi:V1l4: 91:I.;?f/1.r'.:?:X
N
F PO13TL.ANr) OD I I I I I)I..P'T !1(32.60
I I
L. TAX 911.p . :32
Cl'T I�•Ik""13
i.I �.�I I 171='MIz.N'T (::F•IAr1(7,F:4r
c i I i i C)r2M)
O
N Wk--5-TWO(: D (A:)Ar''f.PATTON LN.. 1 ' I RF:F-T)
T
R 30:30 SW MC)(:)I.)Y 1='IyC:(4 )
APOiPOWTI-AND OR 5 7PO.1. r':arr"PAT101 < tG)i'1.6 .GZ.5>
O
R 13E-(:a:1:Si'T rV)'1 r.0N NO . '3 3:±9 'T(YT'AI„. : !kc?:l.6.02
r11 l'ri::r 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 PI: G(ll11;7111)
and all other applicable codes and ordinances, and It Is hereby
agreed that the work will be done in accordance with the plans and 1` IIAM:1:N(*,
specifications and in compliance with all applicable codes and TN!5Ul. AT:l'ON
ordinances. The issuance of this permit does not waive restrictive V;Yr' 1100VID
covenants. Contractor and subcontractors shall have current city e;f.1!il::'1N1') . (:'r.„„:::1:1...7:NC;
business tax permits. This permit will expiry,and become null and 1.: T NAI
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 inspecticos are requested and approved.
Permittee Signature
Issued By .. .. + Z'15 .
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
C1PLAN CHECK APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT Cn o
OREGON PLAN CHERMIT ECK q '� 1 -0
13125 SWFWIBIvd. P.O.Box2x197.T
'°`s°°„972x1(503�819Ai75 DATE ISSUED
JOB ADDRESS: + TAX MAP,/LOT
SUB: -- LOT: _' LAND USE:
VALUATION: —
OWNER SPECIAL NOTES
NAME: REISSUE OF:
ADDRESS: ` LAST REISSUE
_ FLOOD PLAIN/
1 ::k�
PHONE: e
SENSITIVE LAND:
—' - —
APPROVALS REQUIRED
CONTRACTOR PLANN-NG:
NAME: __— }� L�1 14. C _ ENGINEERING:
ADDRESS: , k"e- FIRE DEPT
OTHER:
PHONE: ITEMS RE, U�► IRED
LIST/SUBCONTRACTORS:
ARCif/F�YGINF�'R, BUS TAX:
NAME: CALCULATIONS:
ADDRESS: 1 � ,' TRUSS DETAILS:��
' PARKING PLAN:
LANDSCAPE FLAN: _
PHONE: - �j(r,�{; OTHER:
COMMENTS: _YE 1 l C1 ,
PERMIT # ACCT DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
10-432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5%)
Building
Plumbing _
Mech
10-433 00 Plans Check Fee
Building -- -- -�
Plumbing
Mech
30--207 00 Sewer Connection
30-444 00 Sewer Inspection -
51-41B 00 Street System Dev Charge (SDC) -
52-449 01 Parks. I System Dev Charge (PDC) —
52-449 02 Parts TT System Dev Charge (PUC) _
31-450 00 Storm Drainage Syst Dev Chrg (^aSDC)
10--230 09 IRF[, ---
10--230 06 Washington County Fire NL (95%)
10-220 00 Amar•t/Wedgewood
TOTAL % .�
---- REC N 6) U
APPLTCANT SIGNATURE
Received By: Date Received:
ht/359711/18P