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11885 SW ANN STREET
BUILDING PERMIT APPLICATION TIGARD DATE______ .
THE UNDERSIGNED HEREBY APPLIES FOR A PERMI I FOR THE WORK HEREIN INDICATED PUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE_____.
LOT 140.
OWNER 08UI LUTA'(3111t11 JOBADDRESS 11866 SW Ann Street _
Cle cksamkis ARCHITECT
ENGINEER
BUILDER i1 uf1' P001 1�0. ADDRESS-13765 SE Ambler PJ. DESIGNER
STRUCTURE 0 NEW ❑ REMODEL O ADDITION U REPAIR EIRENEWAL U FIRE DAMAGE ❑ DEMOLITION
0 RES DENCE 11 COMM ❑ EDUCATIONAL ❑ GOVT ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ Si.A81-1 FENCE
OCCUPANCY _ V LAND USE ZONE B-97®a BLDG.TYPE _ _ —FIRE ZONE_—""' PLAN CHECK BY _ 4Wh ._HEAT__._- _'___
------- PiLergless swimming pool, per plans and
rate
acid• _ --
rate mechanical rmit r2gg1rod.
SEWER PERMIT#
OCC LOAD FLOOR LOAD HFIr,HT NO.STORIES _AR,T.ANO.BEDROOMS VALUE
BUILDINt_3 DEPARTMENT _ SET BACKS FRONT REAR i LEFT SIDE RIGHT SIDE
Permit • fl0 THIS PERMIT IS ISSUED SUBJECT TO THE REGUi.ATIONS CONTAINEJ IN THE BUILDING CODE, ZONING
— REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check _ "4.90 WORK WILL BE DONE IN ACCORDANCE PJH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE CODES AND ORDI :'.LACES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Subtotal_ 102.1710 RESTRICTIVE COVENANTS. CONTRACTON AND SUB CONTRACTORS TO NMVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING
State Tax 2.72'
SDC—
Total ;104.72 -
ppC#
By APPLICANT OR AGENT
_ h I
Receipt No.
Ap roved dwh ADDRESS — LLw�PHONE
DATE INSKI TYPE iNspEcTioN REMARKS PLUMBING DATE
Contractor
Permit No.
Hough-in
Fixture
Final
Contracti r
Permit Nn
Got or Oil
Rough-in
Final
Final
DW,VEWAY
Final
Storm Drainage
Main Drain)Final
Curb Stivat Final
Aporosch
---BLDG. DEPT. INNALTPORARY CERTIFICATE OCCUPANCY
I "I
callitTiFICATIE OCCUPANCY li Final
t andscaoing
Zoning Final
L
CIT`( OF TIGARD
P1420 L. W, Main Elms!
TIGARD, OREGON 97
APPLICATION FOR BUILDING PERMIT
New Construction a Demolish AJdition C] Remodel Move C�
ZONING R-7 DATE ISSUED 8-17-73 BUILDING PERMIT
DATE RECEIVED BUILDING FEE $ L�44_ No. - 9
by PLAN CHECK $� 5.0" - ----
--'—' OTHER $ VALUATION $1.000.0"
TOTAL $ 1 00 RECEIPT No. '�7'S
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT M MAP CENSUS TRACT W_ y JOB M
Architect or Engineer Y.N. Luckeroth
Address 11tir35 S.W. Ann Strent Phone 03,)-3062
Owner came
Address Phone
Builder same --- --�"
Address _ _ _ Phone
BUILDING USE Single Res. Multi Res. Comm. F1 Industrial
OCCUPANC) -sRtOUP _ No. of Stories Total Height----.— Area of Lot
Type of Construe I II III IV V Floor Area B` 1 / z
Set Backs: Front_ ck L.Side _ R.S'
Private Sewer Pipe Size ^ S`er� Septic
Water Service Pipe Size St wer Ditch ❑ Drywell❑
Street and Curb Requirements—
Driveway Width No. of Parrt"g Spaces
1---'SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBIN%---`
SPECIAL INFORMATION
lj=X YAT10-DEC3( Wood -- - --
ADDRESS ASSIGNED_ --- 11887 S.W. Anti Street
FIELD CHECK BY KWC "_-_�___"__DATE 8-17-73
PERMIT APPROVED BY "'i: _
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 Occupancy has been issued by the City of
Tigard Building Inspector. '
Signa _u�Applicant
Address 11yY:5 s�' - _xx� Permit No. /3G t)
Permit
Owner ��.[ ;L«cy �� •�(, Connection fee_ •7•;`'`� ___�_
Paid _—
Type of building Rd, Date connected_JQ_�9-70 _..__.___...
Service rate Inspection fee_r g`;
Contractor Paid
Size of connection_ y,� Assessment___ __—Pai.d _
PERMIT TO CONNECT `C
S` Tigard Sanitary District
PERMIT N9 13 6 0 DATE
PFRMIT IS GIVEN TO
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL.CON-
NECTION IS MAIZE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED. 11
PERMIT FEE PAID $ ,�...1. .................TIGARD SANITARY DISTRICT
.–
By _ i
.,...1..
CONNECTION INSPECTED AND APPROVED
Date Superintendent