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11165 SW BOXWOOD COURT
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ddress ��/ �a5� c/ �� Permit No.
Permit charge D_72 tom.
DWnei Connec'.ion fee
Paid by
Type of building : De.te connected
Service rate ��Q Inspection fee
-ontractor Paid by date
Size of i:-)nnection Assessment paid
NILDING PERMIT APPLICATION `IT TIGARD DATE 3-21-77
THE UNDERSIGNED HFH EBY APPLIES FOR APE RM IT FOR THE WORK HEREIN INDICATED BUILDER PHONEA{j � lo,
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS OWNERPHUNF
LOT NO.—
��x't. Lutz 1116t) 3wr+I.axWand Wit. ,
OWNER _ JOB ADDRESS HOME ADDRESS 4�� b 5771
ARCHITECT _
F.DDFtSS
BUILDER ENGINEER
_ DESIGNER
SSTRUCTURE ,ANEW ❑REMODEL ❑ADDITION ❑RE._PAIR ❑RENEWAL RENEWAL____
CTUDAMAGE ❑DEMOLITION
❑vAESIDENcE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO []CAR PORT ❑GARAGE ❑STORAGF❑SLAB ❑FENCE
_❑BOND ❑MOVING ❑CONDITIONAL USE ❑OFSIGN REVIEW _OCUUNCII_APPROVED ❑SIGNS
QS CUPANCY—__LANG USE ZONE_— .—BLDG.TYPE AFIRE ZUNE._ PLAN CHECK BY_ HEAT
�1n L_ �yr►y. PL,,idly jus" C41 UI4LIAL11U SarAWI10_ .3 Caurovm 2 Eii&ttt
—. Ljt _� � tiA 4b E.: 4 _14,A
QCI;.LOAD _FLQQE;_LOAD �; 2tl
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BUILDING DEPARTMENT 20C?1
--- SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONi14G
Plan Check 77 r.t.1 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND 11 IS HEPEBr AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sub-total 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 LICENSE. SEPARATE PE3MITS REOUIRED FOR SEWER, PLUMBING AND HEALING.
Total 237,91
By
-- APPI ICANT nP AGFN1 — - -- --
Approved Recemt No.
---�Nt7NF
DATE INSP.TYPE INSPECTION REMARKSTFerrr.it
PLUMBING DATE-
tor
No, c!' C 6 °�
7 > ORou h•in _
S Z Fixture
Fina: .�—.
1)"26 Jl QHEATING �4
Contractor
Permit No_ ��_
r '18
iL.2)L.2L Gas or oil
Final _
SEWER ~
_ Final
DRIVEWAY
-- _� Final
-- _- Storm Drainage _
(Rain Drain) Final
Sidewalk _
Curb&Street Final
_ A roach
BLDG DEPT, FINAL TEMPORARY CERV IFICATE OCCUPANCY
CERTIFICATE OCCUPANC', Final
Landscaping
Zoning Final �•--�
a
UNIFIED SEWERAGE ACENCY NO.
WASHINGTON COUNTY DATE 3-23-77
CITY OF—Tigard
APPLICATION FOR SEWER CONNECTION PERMIT
OWNER: Art Lutz
OWNER'S ADDRESS: ..------------.--------
STREET
1
CITY
BUILDING SITE: LOT 182 BLOCK ADDITION
TAX LOT NO. TYPE OF OCCUPANCY residence
ADDRESS
DWELLING UNITS FIXTURE UNITS
SURCHARGE IF APPLICABLE
PERMIT FEE 575. INSPECTION FEE 2-5.--- TOTAL DEPOSITED 600.
(NEW) (EXISTING) BUILDING SEWER SYSTEM ---Fannn creak--___
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Ajency.
APPLICANT
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE INSTALLER
/01
RECEIVED BY
IAG=NCY 46 6PO AGM
COMMENTS: Bldg---e 1352
This Application and permit expires in one hundred and twenty (120) days.
The amount paid will be forfeited should expiration occur.