Permit /
1111.
.. Building Permit AppliYtiD An- — -- --- - - FORTIFFICE USE ONLY
q - — — •
Airi f _ Received Building
y d 6 I Os
'a Permit No.: /
City of Tigard `"/ 'II
D
I lig 0 k - Date/By: Planning Approval
,
Other
Permit No.:
13125 SW Hall Blvd. Plan Review Other
- Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 _14/44146.111 Post-Review Land Use
Date/By: Case No. . / it-
Internet: www.ci.tigard.or.us
Contact Jzis.: IZI See Page 2 for
24-hour Inspection Request: 503-639-4175 Name/Method: — 7( C., _ Supplemental Information
-- ff . '4a01.1EMINVOSIVAiKKAOWEVOWatto,IIM
- New cons f4.4Ti:v/T
Ill construction Demolition El t-',;" ' ASa--21, ATOMIINADWIESIANG'45.-
,, -,i44=iA,Ww.',Apit-,“, ..:Ivamvmwtqr*
El Addition/alteration/replacement 0 Other:
2 •Its714.a.iimomoontorcoamanosisifsamom Note: Permit fees* are based on the total value of the work performed. Indicate
0 -1 & 2-Family dwelling 0 Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
El Accessory Building [] Multi-Family
El Master Builder , El Other: Valuation $
::SZM2A0:01$M,Wet'nk:cl:itVV*:tVISh; No. of bedrooms: No. of baths:
Job site address: 1 1 ii5 ,-,..0 (41....tfA) (Du RA Total number of floors
New dwelling area (sq. ft.)
Suite #: Bldg./Apt.#: Garage/carport area (sq. ft.)
Project Name: N-ofri Obsi2-.5 tik frit s itJe.-- Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
PMY - 347.k. el,ritreatVrilVA;I:W7Arle
W.,,,, -` ''' -,',:
Subdivision: Lot #:
Tax map/parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
NitinelftWa:KM the value (rounded to the nearest dollar) of all equipment, materials, labor,
e
01 overhead and profit for the work indicated on this application.
i , -4 4. 4.-" el"-
$ a coo
1 d ' - afi-t-7 xl. -6"/,,,,-e,0.4 Valuation
Existing building area (sq. ft.) /—
. New building area (sq. ft.) i
Number of stories • ,
m 0 Wort7,7 :40 i a r,Va~110414t4M Type of construction
isltr
Occupancy 51■1
Name: . payit„i,, ccupancy group(s): Existing: , 1.4 J „,,
.,
Address: 000 .5 St) /...e..,L Mvy
City/State/Zip; 7 F ntr. q 7/1/6
Ph -
"fl
. NOTICE: All contractors and subcontractors are required to be
ii licensed licensed with the Ore on Construction Contractors Board under
provisions of ORS 701 and may be required to be l in the
one: ..../),3645- 97,5°) ax: ..).3-6, 7 _
iiallottemmatt muttomoutwoNTAky*: g
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:
1-t -'...4kX::,..itiwk-Vitc
1 31,VMOTIZt.S 1 : 0 7-05illavatialiktP4E41 :' ' '' "c"ajiti .. 11" 1 4 216 V"°°
Business Name: .......- . z .....,,z - ,-"-e-. Fees due upon application $
Address: / i.
City/State/Zip: ' , - , / Amount received $ irO
Phone: 303-05 Fax a ,1 - 3 - 9/..V Date received:
CCB Lic. #:
Authorized (..,k.,:l aiA- Date: e/g47 Notice: This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
Signature:
*Fee methodology set by Tri Building Industry Service Board.
(Please print name)
i: \Dsts \Permit Fortns\BldgPermitApp.doc 01/03
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