10815 SW BLACK DIAMOND WAY M
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ADDRESS ' n ? 15' c�u PERMIT Nu.
PERMIT CHARGE none
OWNER .e,y CONNECTION FEE
PAID BY
TYPE OF BUILDING .. DATE CONNECTED
SERVICE RATE �� f� INSPECTION FEE .2.5 , --
CONTRACTOR PAID BY DATE
SIZE OF CONNECTION ASSESSMENT PAID
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SEWER PERMIT NY 15908
if1
Unified Sewerage Agency 5-17-88
of Washington County CITY OF T ig i' DATE
OWNERt Don Hellickson Bldg. , Inc. PHONE :_
OWNER 'S ADDRESS:
TYKE OF INSTALLATION:
0 1BUILDING SEWER ❑ BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY:
"fIT NEW O SINGLE FAMILY ❑ COMMERCIAL
EXIT. (PRIOR TO 7-1-70 ) ❑ MULT. RES. ❑ INDUSTRIAL
FIXTURE UNITS DWELLING UNITS
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ADDRESS OF STRUCTURE : k 10815 SW Black Diamond Way
PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPLY WITH ALL RULES AND
REGULATIONS 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.
FEESt
PERMIT FEE 25.
CONNECTION CHARGE 600.
SIDE SEWER INSTALLATTON _ B. Greene -
ISSUED BY
OTHER
TOTAL a 625.
DATE
r 'TC n _ N? 15808
���,t� u��� t <<s SEWER PERMIT
ADDRESS OF STRUCTURE 10815 SW Black Diamond Way
TAX MAP TAX LUT SYSTEM Panno creek
LOT 25 _BLOCK _ OF
E. Walden 5•-17-78 tom . ��
_ f .✓ L_
APPROVED BY DATE r ISSUED BY) dATE
D.U. 'S 1 REMARKS bldg. # 2101
BUILDING PFRMIT APPLICATION LOF TIGARD DATE---ry —
I;sn
THE UNDERSIGNL') HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANY'NG PIANS AND SPECIFICATIONS. OWNERPHQNF —
^1C LOT NO.— —_
OWNF-R`Oil }ibli iQ�Ck91]ji f7.UOB ADDRESS 6r Fr: .. Y11i1CIf UiSMOWOMAbVRESS _
ARCHITECT
Ejamw 2760 SE Hollyhock (4.. r'.BMG#r+IfVR
BUILDER ADDRESS DESIGNER
STRUCTURE_''QNIW ❑REMr1DEL El ADDITION C3 REPAIR ❑RENEWAL — ❑FIRE DAMAGE _ ❑DEMOI_ITIOY
[30ESIDENCE OCONIM DEDLICATIONAL E3GOV'T ❑RELIGIOUS❑PATIO [:]CARPORT ❑GARAGE ❑STORAGE❑SLAB ❑r=ENCF
_ OBOND ❑MOV 41G P,,ONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPRO_V&D ❑SIGNS
OCCUPANCY r1p'�_LAND USE ZONE r �7 —BLDG TYPE = FIRE ZONF._ PLAN CHECK BY F EAT_,. _
singi.ta family dwellmy w/attached gsrage 3 bedroom 7 both `
garage b04
--
(?CC SOA 40 --HZIGHT 2U__N0.5,TCIRIES I —AREAl6i6_-N0,BEDRQ0r0S 3 NALI'F 4t"I
---__,.FLQ-QR I.SZr�1►t_ _
BUILDING DEPARTMENT20 . 36 t
_— — SET BACKS FRONT .TEAR LEFT SIDE RIGH?aiOE
178*00
- ' THIS PERMIT I< ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILulNu CODE, ZONING
Plan Check 89.00 REGULATIONS AND ALL APPLICABLE CODES ANC ORDINANCES, AND IT IS HEREBY AGRF ED THATTHE
-' WORK WILL BE DONE IN ACCORDANCE WI TH THE PANS AND SPECIFICATIONS AND IN COiAPI.IANCE WITH
Subtotal 2O7000 ALL APPLICABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RE"TRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVF. CURRENT CITY BUSINESS
State Tax 7. 11 LIsGA:$E:5EgftT: PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
'Total 274.12 X.C. #1 $1000
By APPLICANT OR AGENT
Approved Receipt No. 1
� It/
DATE INSP, TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
--—— -- Permit No.
`— �----
no Kph in
7-7-,7 - —`�� ____. Fixture
Final
HEATING
Contractor
• iD Permit No. I 7/ g 71317Y
Gas or Oil
& Rough�in
uA( l -
Final
SEWER
-- Final
DRIVEWAY
Final
Stonh Drainage
(Rain Drain)Final.
Sidewalk
Curb&Street Final
Approach
BLDG.DEPT.FINZ TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY
Landscaping
Zoning Final
C • C_ C..
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