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11355 SW COTTONWOOD LANE
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OF
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CITY OF TIGARD AC y<..
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4 Art Lutz c� Co Pe `S
0«ner ... Permit No. 321 ��++
............... .....
11355 SW. Cottonwood Lane
Building .'Address..... .. .. ........ .. .. .......L.at...#16.3. ......._... �
C� rtificate is hereby given this-....e.........day of.A4.g�'9.t............... 1� ..'1.7..
that said building may be occupied and it `
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a: F that it romplies with all requirement. of
. the Building Code for the City of Tigard,
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as approved by the Tigard City Council.
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Building InsImetor
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Cit of Tigard
City ga d
INSPECTION REQUEST
fo �
I ►SPECTION TIME: PERMIT NO. :
DATE: A �
��' DATE I SSIIED :__ / /
`WNERS NAME :
__
ADDRESS: / -� 3- - &tl 1
►u T R A C T O R : !/ 2!1-
a r . Air [.j, Water p , Visual O l_oN7►c�tor I
yp I
'cSULT. Approved
- [j/Disapproved C , pending
M:-, O
SKETCH.'
E TOR DATE
rM(11E. hf}nrh 1t-pr omp-nfnl leg doto beret I
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City of Tigard
INSPECTION REOUES► .
INSPECTION TIME ' PERM±i NO. :
DATE ; i/7/ 27 DATE ISSUED'.��_._
OWNERS NAME : 2—
ADDRESS :
ADDRESS : �,3-') �-
CONTRACTOR :_4Pti,L¢_�___
TEST . Ai: C7, Water o , Visual ❑ , Laboratory p
RESULT: A roved (��Diea
Y PP pproved [I , Peni+nq f--
SKETCH.'
-SKETCH: K- _ 7t
VL _
2
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INSPE -OFA DATE
T
ICOTE . Attcch Supplemental toot data hereto
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01
AGENCY
IvIVASHINGTON COUNTY DA I E 2-
Z5-7 7
CITY OF --_
APPLICATION FOR SEWER CONNECTION PERMIT
OIA/h,r
Lutz
OWNER'S ADDRESS:-
STREET
CITY -STATE
BUILDING SITE: LOT. 163 zIP
BLOCK --_ ADDITION
TAX LOT NO. -- TN'PE OF OCCUPANCY-
ADDRESS 11355 SW C-Ottom,ynod- Lgne
DWELLING UNITS FIXTURE I 'NITS
SURCHARGE IF APPLIC48LE
PERMIT FEE
FLE 25.__._ TOTAL DEPOSITED 600
JNEW) (EXISTING) BUILDING SEWER SYS I EM Fenno Creek
Thp Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
APPLICANT
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION -10 THE SEWER SYS*IEM,.
LINE C'17r INSTALLER
RECEIVED BY-L- 7,
(AGE NCY 6R 'I
COMMENTS: Bldg. #1321
This Application and permit expires in one hunrired and twenty (120) days.
The amount Paid will Le forfeited should expiration occur.
BUILDING PERMIT APPI (CATION 1U Y TIC ARD OATS 1-2A"7� '�
THE UNDERSIGP;ED HEREBY AP"LIES FOR APERMIT FOR THE ?;0RK HEREIN INDICATED BUI -)ER PHONE_
OR AS SHOWN AND APPROVED IN THE ACC'Jh1F'ANYI.NU PLANS AND SPECIFICATIONS. OWNER PHONE
LOT NO.
GWNER ..JOB ADDRESS i Ty.�,7t1Wt]❑� ISM ADDRESS �—
— ARCHITECT
ENGINEER
BUILDER ADDRESS DESIGNER
STRUCTURE (30EW O REMODEL ❑ADDII-T7ION ❑REPAIR ❑RENEWAL_ ❑FI�R-1E DAMAGE ❑DEMOLITION
01-ESIDENCE ❑COMM ❑EDUCATIONAL_ ❑GOV'T (_,RELIGIOUS❑PATIO ❑ [,
CARPORT ❑GARAGE STORAGE❑SLAB ❑FENCE
_ ❑BOND ❑MOVING ❑CONUITIC USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
QCCUPANCY=_ELAND USE ZONE— A"l BLDG,TYPE r,4- _--FIRE ZONF—_�' PLAN CHECK @Y_ »LLQ' � HEAT_ L�_
L0113t. sigole family dulling u/attached yaraWu - Li L 1u3 A Utriroom 2 �IJkitrl _
garags 500 sg. Ft.
OCC.LQAIL_ FLOOR LOADXF,�SzHT __%D.._LIQ•�IQHI€�_�_._AREA .14,4 l NO.BEDROOMS d VALUE-';'
•' '
BUILDING DEPARTMENT SLT BACKS FRONT 2(:I REAR 3Q♦ LEFT SIDE RIGHT SIDE
Pel mit 1361 Qui
THIS PERMIT If: ISSUFO SUBJECT TO THE REGULA'IOI'% CCLNTAINED IN THE BUILDING CODE, ZONING
Plan Check 68900 REGULATIONS AND ALL APPLICABLE CODES AND ORDIN. ----fS, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE.PIANS AND SPECIFICA(IONS AND IN COMPLIANCE WITH
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 6,21 LICENSE. -PARATE PERMITS REOUIRED FOR SEWER, Pt UMBING AND HEATING.
Total 210.11
BY - -
__ APPLICANT OR AGENT
Approved At, � Receipt Ne
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UATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
ontractor
t Permit No.
Rough-in _
Fixture
L'
C Final
HEATING
/Y/-;7 Contractor _
;)91-71 Permit No. '3�j�
Gas or Oil
Rough-in _
-\ Final _
SEWER
-- Firral _
DRIVEWAY
Final
Storm Draina
JRain Drain) Final
Sidewalk
Curb&Street Final
_
Approach
BLDG DEPT. FINAL TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final
�- Landscaping
Zoning Final
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Address _//3��' (��= a, �' � e Permit No. //6, 71
Permit charge 7j 0?
0wI10r :;? _ %j Connectian fee — t;5- �u
Paid by
Type of buildings Date connected
Service rate Inspection fop
Contractor Paid by date
Size of connection Assessment Paid
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