Permit CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
A + J ELECTRIC
PO BOX 330
FOREST GROVE, OR 97116
Electrical Signature Form
Permit #: ELC2003 -00421
Date Issued: 1/13/04
Parcel: 2S115AB -01900
Site Address: 16200 SW PACIFIC HWY A
Subdivision: TIGARD TOWNE SQUARE
Block: Lot:
Jurisdiction: TIG
Zoning: C -
Remarks: Electrical work to convert day care to restaurant. Service panels and branch
circuits.
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
BIT HOLDINGS LTD PARTNERSHIP A + J ELECTRIC
BY FORUM PROPERTIES INC PO BOX 330
FIVE CENTERPOINTE DR STE 290 FOREST GROVE, OR 97116
LAKE OSWEGO, OR 97035
Phone #: Phone #: 359 - 5891
Reg #: LIC 959
ma c , y'S SUP 4534S
ELE 34-1C
•
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signatur of Supervising Electrician
If you have any questions, please call 503.718.2433.