12372 SW KING GEORGE DR BUILDING PERMIT APPLICATION con-FY
TIGARD DATE C d? . 19 13 N° ,
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONF
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONF
LOT NO
' • ER JOB ADDRESS / 2_-3 p 2. $ V ,��� A I / DDRESS
4 11 .l ARCHITECT
ENGINEER
• DER i .. /a• ADDRESS DESIGNER /
.ICTURE DNEW /D REM DEL El ADDITION REPAIR DRENEWAL DFIRE DAMAGE DDEMOLITION
FSIDFNCE DCOMM DEDUCATIONAL DGOV'T DRELIGIOUSDPATIO D CAR PORT DGARAGE D STORAGE DSLAS DFENCE
I IIBOND DMOVING DCONDITIONAL USE DDESIGN REVIEW DCOUNCIL APPROVED DSIGNS
C :"_CUPANCY_ -_ LAND USE ZONE BLDG. TYPE FIRE ZONE— PLAN C CK BY HEAT
APW
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N ( '..�.Niuie • I -
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Jr ;C..LQAD FLOOR LOAD HEIGHT NO STORIES AREA NO. BEDROOMS ALUE1! 0
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT
Permit i5 cte-
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
I. Subtotal ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
• RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax /Q 72-- LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total (/I / P-- �! — � 1/ S Y �
B ' APPLICANT OR AGENT
Approved Receipt No.
ADDRESS PHONE
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