10760 SW BLACK DIAMOND WAY 1
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=.ddrG:,s 10 Permit '!o. y g Ji
Permit charge n
Cnnnrction fee
Paid by
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f��/ Date ConnE Ct�!d
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Jrltractor Paid by date,
ize of ion Assessment Paid
SEWER PERMIT N 15879
Unified Sewerage Agency
of Washington County CITY OF j i Orsi DATE 4-27-78
OWNER : _ 1 R QrnQRrt.i RS PHONE :
OWNER 'S ADDRESS:
TYPE OF INSTALLATION:
'0 BUILDING SEWER ❑ BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY:
>DNEW EIMNGLE FAMILY ❑ COMMERCIAL
❑ EXIST. (PRIOR TO 7- 1-70 ) ❑ MULT. RES. ❑ INDUSTRIAL
FIXIURI_ UNITS _ DWEI.LING UNITS IL
ADDRESS OF STRUCTURE : _ 10760 Black Diamond Way _
PERMIT CONDITIONS : TH` APPLICANT AGREES 77 COMPLY t4ITH ALL RULES AND
RE ULf,TIONS OF THE UNIFIED SEWERAGE AGENCY. WHEN CALLING FOR INSPECTION,
PLEASE REFER TO THE PERMIT NUMBER. THIS APPLICATION EXPIRES IN ONE-
HUNDRED AND TWENTY ( 120 ) DAYS. THE AMOUNT PAID WILL BE FORFEITED SHOULD
EXPIRATION OCCUR .
FEES:
PERMIT FEE R_ 25,
CONNECTION CHARGE 600,
SIDE SENIER INSTALLATION _ B. Greene
OTHER
ISSUED BY
I TOTAL y 7 625.
APPLICANT GATE
SEINER PERMIT N? 15879
ADDRESS OF STRUCTURE _ -� 10760 SW Black Diamond Way
TAX MAP TAX LOT SYSTEM fanno creek
LOT _ BLOCK 0
E. Walden
APPROVED BY DATE ISSUED BY MfE'
D. U. ' S 1 REMARKS bldg. #2061.
i
BUILDING °FRMIT APPLICATION `'OF' TIGARD DATE 6'-27-7,; _ Is
THE UNDERSIGKFD HEREBY APPLIES FOR APE RMIT FOR THE WORK HEREIN INDICATED SUILDERPHONF� -• 11 6
OR AS SHOWN .AND APPROVED IN THE ACCOMPANYPIG PIANS AND SPECIFICATIONS. OWNER PHONE
PrLl LOT NO.__
OWNER '• • p�'�'t•��{� �or�nDDREss �.t'7fi0 5W .�a�r.k ---
W}lbmr� —
NbME.'AbbRESS
ARCHITECT -'---
BUILDER (flt ENGINEER
ADDRESS DESIGNER
STRUCTURE %�10JTJEW _ORFMC)UEl ❑ADDITION _ OREPAIR EIRENEWAL ❑FIRE DAMAGE ❑pEMOL'TION
D'AtSIDENCE OCOMIA OELUCATIONAL_ OGOV'T URELIGIOUS OPATIO ❑CAR PORT ❑GARAGE O STORAGE OSLAB ]FENCE
OHOND OMO'Irmu OCONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED _ ❑gIGNS
OCCUPANCY_.:—.LAND USE ZONE_ J {+ w
BLDG.TYPE ZONE,i PLAN CHECK BY Atli
-_------ HEAT
I .L. is.nWle fOM11Y dwellim, u at:tacl,d_ ud 16UP!. 2 beth
4A.
ewer permit: giso7g _ --
411 Hg1SiHL- 0.__._NQ.-�I_Q$!€�. - AN-A :=:67
--N.Q.ME�4S2lN�- .�---
BUILDING DEPARTMENT — SET BACKS FRONT 22 ��
-- _ REAR LEFT SIDE 12 RIGA'SIDE 1(.i
l
THIS PERMIT IS ISSUFO SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDINJ CODE., ZONING
Plan Check ;•�I� _ REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Sub-total
WORK WILL OF DONE IN ACWRDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPIAANCF WITH
ALL APPLICABLE CODES AND ORDINANCES. THF ISSUANCE OF THIS PERMIT DOES NOT WAIVE
State Tex
RES1AICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINEFS
b,f'� LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total .3i�U,
- 25.,,64 -
• 91 $1D.
By
APPLICANT-6—PRG—ENT "---
Approved qf,r HFreipt No.
�� AT,
DATE INSP. TYPE SPECTION REMARKS PLUMBING DATE
S / / a Contractor
— —' -- - Pe mit No.
Rough-in ^
Fixture --- —
�, I — Final -- -
„�� HEATING
Contractor
t
mit No.or Oil,gti-in —
__�.. Final ------ -
SEWER
— --�—��—
Final ---
A -- ----� - — DRIVEWAY -
- - -- --- ---- — Final
Storlh Drainage
(Rein Drain) Final
Sidewalk
Curb&Street Final
Approach
BLDG. DEPT. FINAL _ TLMF ORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final
i
Landscaping
Zoning Final