12080 SW KING RICHARD DR •
CITY OF
BUILDING PERMIT APPLICATION TIGARD DAT , 19 N2 _
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HE N IND ATED
• OR AS SHOWN. AND APPROVED IN HE ACCOMPANYING PLANS
O�✓ PL AND SPECIFICAT , S.. OWNER PHONE
OWNER wii ADDRESS /2-4 � � -�N�y� , BUILDER PHONE
ENGINEER
Eli 'I ( p ARCHITECT DESIGNER
STRUCTURE ONEW ❑ R ODEL y ��11 ❑ADDITION Eal,REPAIR ❑RENEWAL FIRE DAMAGE ❑DEMOLITION
• RESIDENCE ❑COMM DEDUCATIONAL DGOV'T ❑RELIGIOUS OPATIO ❑CAR PORT. OGARAGE ❑ STORAGE OSLAB ❑FENCE
OBOND 0 MOVING ❑CONDITIONAL USE 0 DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCC ,;ANCY LAN• USE ZONE BLDG. TYPE FIRE ZONE_ PLAN CH K BY HEAT
1 .. - :: , . s2.2. / 2e . /
OCC. LOAD FLOOR LOAD HEIGHT NO. STORIES AREA VALUE gBS�
I BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
' Permit II / •
I THIS PERMIT IS. ISSUED SUBJECT TO THE REGULATIONS •
CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES. AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
t‘)St RESTRICTIVE COVENANTS. CONTRACTOR Ar. ;R CONTRACTORS TO HAVE CURRENT CITY BUSINESS
1 3 LICENSE. SEPARATE PERMITS REQUIRED FOR •vER, PLU ND HE TING,
Total 41 / .
By ll
lA L Al N 1/4)4 MOE 4. .4
Approved . I Receipt No. _ 6.3 ' 76 a
ADDRESS PHONE
'KING'" URAL_CNANGE_RE4UEST
Member bl /lp4,1 Date
Address • f • ,�_., �I Phone 634
TYPE OF CHANGE
(Patio Cover, Room, Fence, etc.)
PLAN: DIMENSIONAL AND MATERIAL DETAILS
4 d f r ' f " c-/144
/
v
Note:
1) Adjacent property owners will be informed of the requested change.
2) If there is an objection, the objection, but not the name of the objector, will
be given to the member asking for the change.
3) The Board of Directors of the Civic Association will review the plans and property
for approval or disapproval and compliance with the stated restrictions.
4) A building permit must be obtained from the city for all improvements costing over
$500.00
Date Notified / KCCA Board of Directors
President
Date to be Completed C Approved Vice President
Final Inspection owed (Reasons)
.4(te4