Permit .. Building Permit Appl at "' 1 I •,` - d FOR OFFICE USE ONLY
Received d' 65 1 Building
6 �'►, Date/B b Permit No.: 5 —. 006 . 0/
City of Tigard 8 (/" ( _& Plannin App Other
U Date /By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
- Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 I ' 41 4�lI 11,; Post- Review Land Use ,, /�
Internet: www.ci.tigard.or.us ` -. a Date/By: Case No. Contact �J i ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: f t Co Supplemental Information
•
;' X_ :*..,`At" �"�' - ix'a � VW:.��:,: dill x MVR4ert P - eun .a._ - a,u.; _
Li New construction Demolit ,5 �_ -
❑ Addition/alteration/replacement ❑ Other: •
'• ,at=;fi, ^; C A O:QI rf ) S, gta IO ` , ± y Note: Permit fees* are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
❑ Accessory Building ❑ Multi- Family
❑ Master Builder ❑ Other: Valuation $ _
,., harlot ST' I O iat " : & , `'"E
No of bedrooms: No of baths:
,� . > �0�. �'� "d I.O�OA TON:::,. .;�,:�, : .
Job site address: // 1,54 - G /Ltf J2( Total number of floors
New dwelling area (sq. ft.)
Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.)
Project Name: " RT7. F, 1 ,yr, eas, No i s /0e) Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
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. : ` , ci E , , g k si p CH ECRI.Y.s % 10 5 , `
Subdivision: Lot #: idea. .� 4�Ariz t� � *6; 4 ,,_ . te
Tax ma . /parcel #: . Note: Permit fees* are based on the total value of the work performed. Indicate
b fel _" .- b E c aMA i ` q .; . �`" " !-,m the value (rounded to the nearest dollar) of all equipment, materials, labor,
� j 4 d /l . ® �`
■ overhead and profit for the work indicated on this application.
W � 2� w01. ,` \ /I /v .r, / . Valuation $ 4D d
'� �/-, Existing building area (sq. ft.)
. New building area (sq. ft.) i
_ Number of stories
ft a'` �3' 9_R =�`" : Tw , 4,._ Type of construction /s3
� ` traction
Name: ,per / 4 % Occ upancy g roup(s): Existing: /� /
v ., ��.. New: JZ )
Address: , 00 iva . •
City /State /Zip: it e77//(.)
NOTICE: All contractors and subcontractors are required to be
Phone: .513- & � Fax: .563-6 545- licensed with the Or e on Construction Contractors Board under
CA y am. .... g
Y���l�� �°` � � '��� �.�' ��,CO��A,P
prov of ORS 701 and maybe requ to be licensed in the
Business Name: jurisdiction where work is being performed. If the applicant is exempt
Contact Name: from licensing, the following reason applies:
Address:
City /State /Zip: .
Phone: Fax
E-mail : i , &< I .
i z x - `e'' „: R s �, : . . �`e�,:. x "a`a ICaSei f 1- e v ale #' ,�,` a. A.
Business Name: ,....., " - , / "0"-e-. Fees due upon application $
Address: "00 _ I. - - - - . � .
City /State /Zip: '. - , ' / _ /"7/6r Amount received $
Phone: Sa3 -,�3 - 9/$ Fax ecj3 -6 941I Date received:
CCB Lic. #: __
Authorized ( aIL_ 9 / /� Date: �j Notice: This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms\BldgPermitApp.doc 01/03