BUP1974-0100 CITY OF T'IGARD
12420 S. W. Main Street
TIGARD, OREGON 97223
APPLICATION FOR BUILDING PERMIT
New Construction ❑ Demolish ❑ Addition 11Remodel Move ❑
ZONING DATE ISSUED 6,7 y BUILDING PERMIT
DATE RECEIVED
BUILDING FEE $ Z,0-0No. -7
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BYPLAN CHECK $
OTHER ALUATION
TOTAL RECEIPT No. /Oa2k_r_
,-- -;7
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
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LOT # 3C �J� MAP # < yoo CENSUS TRACT JOB #
Architect or Engineer
Address "'
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Owner
Address Y l;• ., -� Tom,— ���,T���, Phone
Builder
Address Phone
BUILDING USE Single Res. ❑ Multi Res. ❑ Comm. 0 Industrial ❑
OCCUPANCY GROUP No. of Stories Total Height Area of Lot
Type of Const ction I - II III IV Floor Area B 1 2
Set Backs: Front Back L.Side R.Side
Private Sewer Pipe Size Sewer eptic Tank ❑
Water Service Pipe Size torm Sewer ❑ Ditc Drywell ❑
Street and Curb Requirements
Driveway Width No. of Parking Spaces
SEPARATE PERMITS- REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
&Z-1-1--t e),le Z /1' C,4�
ADDRESS ASSIGNED // V 416
FIELD CHECK BY DATE—,Z,Z, 7 y
PERMIT APPROVED BY
It is understood that all work will conform with applicable codes and ordinances
of the State of Oregon and the City of Tigard, Oregon, and that the building will
not be occupied until a Certificate of Occupanc has been issued by the City of
Tigard Building Inspector.
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