HOP2000-00012
HOME OCCUPATION
TYPE I APPLICATION
CITY OF TIGARD 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639-4171 FAX. (503) 684-7297
GENERAL INFORMATION
Property Address/Location: //'0/$- c 5k) Tax Map & Tax Lot 15 /.>--0 V60 Zone:
Property Owner/Deed Holder(s)": 1_7bjn ,4, FelZM FOR STAFF USE ONLY
Address: Phone:S4-~t~q~
Case/Permit No.:
~j`pf ~DLYj " Q56f a
City:ff~Z/~ Zip:~~~ZZ3 Other Case No.(s):
Applicant': TlfO/66 ~/L^f~C-E Filing Fee Rec'd.:$ 60.00
Receipt No.:
Address: //O~SSkJ~~r~ itrd~ ~IC~Y Phone: _P9101?
Business Phon : $x4'py"5? Application Approved
C"( 3.f1 -,Z o ev Date Approved: .,~P4 -00
City: Ole- Zip: 9,;2 3
' IL/
Business Name: Th0/bfXS H, f 6 ey-a 17t`;F_' Comp Plan/ 7ne Designation:
Nature of Business: f46XI'Pi! 7X 4-L ,02T- 7
Business Tax Paid? ~ Yes ❑
Business Tax Receipt No. po -6AI
Rev. 11/26/98 is\curpin\masters\hop1.doc
When the owner and the applicant are different people, the
applicant must be the purchaser of record or a lessee in possession
with written authorization from the owner or an agent of the owner.
The owner(s) must sign this application in the space provided on the
back of this form or submit a written authorization with this
application.
REQUIRED SUBMITTAL ELEMENTS
THE APPLICANT SHALL CERTIFY THAT:
✓ The above request does not violate any deed restrictions that ✓ Application Elements Submitted:
may be attached to or imposed upon the subject property_
✓ If the application is granted, the applicant will exercise the rights EJ Application Form
granted in accordance with the terms and subject to all the Q`Owner's Signature/Written Authorization
conditions and limitations of Xhe approval.
Q" roof of Business Tax Certificate
✓ All of the above statements and the statements in the plot plan,
attachments, and exhibits transmitted herewith, are true; and the [a'-Filing Fee: C.O.T. Fee: $ 30.00
applicants so acknowledge that any permit issued, based on this URB. SVCS. Fee: $175.00
application, may be revoked if it is found that any such statements
are false.
✓ The applicant has read the entire contents of the application,
including the policies and criteria, and understands the requirements
for approving or denying the application.
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