InitiallyGood ra
r '
00
Ln
C)
rn
HQ
Z
H
i
i
I I
r
Illi
12935 SW ASCENSION DRIVE —..
CITY GF TIGARD �==
COMMUNITY DEVELOPMENT DEPARTMENT
13126 3W Hall Blvd.Tigard,Oregon 9722398199 (503)530-4171
i
}
T
ryry 017r .
alp,+�i/f n n. "+ll �F�� /l', �.}F .¢" m�'J 6'y.:l l8i 1:. �.. �,". n � I':1'l_ ��.�� ___.._...............•_.___—_._....
3
., _ ., •,�t. .�., :,Nye ,�
Jdft1. F;ii
W a es, The Agv;q does ut j rarU i ti d +` -
'c .::i,.:;i' 1>fr!''r��=• Tf t4 tPW a {• 4pt
ell
't,77
�jG - 77.37
Residential Building Permit Application
City of Tigard
13125 SV+! Hall Blvd.
Tigard, OR 97223
(503) 639-4171
/ � 9��� ,5�� �SC
Jobsite Address:
Subdivision: Lot# Office Use Only
Contact Date _ ! ! Initials _
Valuation: _ _ Result
New Construction Only: (Square Footage) Planck/Rec #
Permit # 7i, i<<' 7 -031
t louse _ _ Garage: __ _�. _ Reissue of_
Map & TL
Corner '-ot? Y N Flag Lot? Y N Lone
�//�, � Plat #
Owner: (td(Z JVDI TO A ,__F'J�Y --
/z J� 5-W 4 SG94V$Sl'oN "Ode Approvals RPg<uired
Address. : Q 3tT'-FF7Z"'3'T' _
Planning Setbacks Solar
Tt Cst r,�T 41Z T 7 z L s Engineering
Phone L5r_?. ) S Alf Other-- -
items Required
Contractor-
Subcontractors
Address Truss Details _
Other
Phone. ( ) Notes
Contractor's License #
(attach copy of current Oregon license)
Contact Name
Contact Phone.
Subcontractors: Architect/Engineer:
Plumbing: Y Address
Mechanical:
(attach copy of current OR Contractor's License)
Phone:
JOB DESCRIP"PION: SE (1 fla%L4, o!- f+rbl5F A. oJS Dh' Dlrukto/��IYNf-
Applicant Signe re Applicant Phone number
Received by: i %/ Date Received.
w wanmnvoue ~
Permit ,,$ Account Description Amount Amt. Pd. Bal. Due
_ — Bldg. Permit (BUILD)
Plumb. Permit (PLUMB) _
Mech. Permit (MECN)
State Tar. (TAX)
i3idg:
Plumb*
Mech:
Plan Check (PLANCK)
Bldg:
Plumb:
Mech:
Sewer Connection (SWUSA) l _
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC) _
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS)
Office TIF (TIF-0)
Water Quality (WQUAL)
'Nater Quantity (WQUANT)
Fire Life Safety (FLS)
Erosicn Cntrl Fennit (ERPR,MT)
Erosion PlanckJUSA (ERP LAN)
Erosion Planck/COT (EROSN)
TOTALS:
BONNEVILLE _ POWER ADMINISTRA
14 5Zo (OLD ALc:t,,`�. T.
-
' cn
III -
O