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SEWER PERMIT
W
N133422
U
Unified Sewerage Agency
of Washington County C ITY OF__ Ti card DATE 6-21-77
OWNER : _ Bob Smith PHONE : 644-8955
OWNER ' S ADDRESS:
TYPE OF INSTALLATION:
0 BUILDING SEWER ❑BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY:
❑NEW Q SINGLE FAMILY ❑ COMMERCIAL
[]EXIST . (PRIOR TO 7- 1-70 ) ❑ MULT . RFL, . ❑ INDUSTRIAL
FIXTURE UNITS DWELLING UNITS l
PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPLY WITH ALL RULES
AND REGUL_ATIO14S OF THE UNIFIED SEWERAGE AGENCY . WHEN CALLING FOR
INSPECTION, PLEASE REFER TO THE PERMIT NUMBER, . THIS APPLICATION
F_XPIRES IN ONE-HUNDRED AND TWENTY ( 120 ) DAYS. THE AMOUNT PAID WILL
BE FORFEITED SHOULD EXPIRATION OCCUR.
FEES:
PERMIT FEE 6 25•
C014NECTION CHARGE 575•
SIDE SEWER. INSTALLATION
_
ISSUED BY
OTHER
TOTAL b 600.
I CANT DATE
SEWER PERMIT M 13422
ADDRESS OF STRUCTURE— _ 11335 SW Cottonwood Laae
TAX MAP TAX LOT SYSTEM fen,io Creek
LOT 165 BLOCK OF
APPROVED BY DATE ISSUED BY DATE
REMARKS bldg. i5fpZ1536
BUILDING PERMIT APPLICATION " TIGARD DATE 6-21 .77 19 _ 1536
\ THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR "FHE WORK HEREIN INDICATED BUILDER"HONE16 "955
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECiFICATIUNa. OWNERPHONF
LOT NO.
OWNCJOB ADDRESS '(1,335 JU �Ut lkMoOd HOME ADDRESS
ARCHITECT _
yamiar ENGINEER
BUILDER
^1 ADDRESS DESIGNER
STRUCTURE 'OJ FW 1:1 REMODEL El ADDITION ❑REPAIR _❑RENEWAL Cl' IRE DAMAGE [:]DEMOLITION
Q*SIDENCE ❑COMM ❑EDUCATIONAL. ❑GOWT ❑RELIGIOUS❑PAT:O ❑CARPORT ❑GARAGE ❑STORAGE❑SLAB ❑FENC-
❑BOND C1 MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY �— LAND USE ZONE_ BLDG. TYPE ' _.FIRE ZUNE _� PLAN CHECK BY U�tJ — — HEAT_ +J`
!.onst. &,Ln;;Jle family dwellig%j u/attached gabaroje split level
3 hekeirnn I -1 Lath 1m5S A40 —
HEIGHT_—__ NO.STORIE,$__Z A3E�490NO.BEDROQMS 3 VALUE_4 0
BUILDING DEPARTMENT SET BACKS FRONT 20 REAR 6(7+ _FFT SIDE 1Q RIGHT SIDE
Permit 166*00 -- - —� —�-
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILLING CODE, ZONING
Plan Check 10.00 RFGULATIONS AND ALL. APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFIrATIONS AND IN COMPLIANCE WITH
Subtotal ALL APPL(CABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PFRMII DUc'.S NOT WAIVE
—� RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 5.A]l LICENSE. SEPARATE PERMITS REOUIREO FOR SEWER, PLUMBING AND HEATING.
Total �� l :;1.iH Y:;l,lJln ,.a:JVlIlUrJrlf2ttl t, tt�lr�aa ,;iiJ.Ufi
By
—+—� APPl ICANT OP ARGENT --
Approved W Receipt No
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DATE INSP. TYP'?INSPECTION REMARKS PLUMBING GATE
tRough
tractor
it No.
L[_b/A� cr/ZOU'v� �JLUh6w4 -- —
6 ure
--
Final_ _
L—'7 2-1 T3) HEATING
Contractor
Permit No. ?
Gas or Oil
,�,,� -- - - -
Final
--- --- SEWER
_ Final
----.— -------- DRIVEWAY —
__ Final
Storm Drainage
(Rain Drain) Final
—---- - Sidewalk --
- -------.---.- — — Curb&Street Final
BLDG DEPT. FINAL CERTIFICATE O
TEMPORARY F —CCUPANCY AL�roach
T
CERTIFICATE OCCUPANCY Final
( Landscaping —
Zoning Final
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