13040 SW CARMEL STREET-1 i'armc1.
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WATER f[ERIT �-
CITY OF TIGARD
12420 S. W. MainStreet
TIGARD, OREGON 97117
APPLICATION FOR BUILDING PERMIT
New Construction ❑ Demolish ❑ Addition Remodel ❑ Move❑
ZONING DATE ISSUED BUILDING PERMIT
DATE RECEIVED BUILDING FEE $ I/iNo. �I
PLPN CHECK $ /`/- �s
BY-
OTHER ALUATION
TOTAL $ r RECEIPT No.
9/t
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT 1 MAP A CENSUS TRACT JOB #
Architect or Engineer _, f
address Phone
.owner ST aw gR1P
Address
130-10 S'•1t1, Cla 1ZMC Phone
"uilder_ S—( e%"ART' Sk)e1-L_ ZIMAR(C Spe-TNE�11
ddress 13040 S.Q.U. l,:AR t%t L,_ Phone`_
BUILDING USE Single Res. ❑ Multi Res. ❑ Comm. El Industrial❑
OCCUPANCY GROUP No. of Stories �_ Total Height _ Area of Lot _—
Type of Construction 1 II III IV V Floor Area B____ 1 _ 2`_
Set Backs: Front _ Back L.Side_ R.Side_
Private Sewer Pipe SizeSewer___ Septic Tank ❑
Water Service Pipe Size _ Storm Sewer ❑ Ditch ❑ Drywell❑
Street and Curb Requirements
Driveway Width _ No. of Parsing Spaces--
SEPARATE PERMIPS REQUIRED FOR SEWER AND PLUMBING
/�
SPECIAL INFORMATION
daffy. Ot u J r .7-'. _fa 7�1lr��- .. __.
/DDRESS ASSIGNED 13oV,1 mss,
FIELD CHECK BY DATE
PERMIT APPROVED BY-���- --s•✓f
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 Occux>> 1 has een 3 rued by the City of
Tigard Building Inspector. atur
Signof Ap?1 cant