11720 SW BURLCREST DRIVE-1 i
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PUILDING PERMIT APPLICATION COF TIGA�RD D4TE_ _ri=�A"�e ty-- 2
114E UNDERSIGNED HEREBY APPLIES FOR APE RMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE P :COMPANYING PL-ANS AND SPECIFICATIONS OWNERPHONE
LOT NO._.___
OWNER S,ij j jj dM k, $ChQ0JV d ADDRESS.I D i0 5W bUZ I Gx 6i6� e.. aFIAME,\DDRES,
-"-- — ARCHITECT
ENGINEER
BUILDER I-,!lith 31an UrS ADDREbzD _ DESIGNER
STRL"TURE ENEW _❑REMODEL UAIDITION ❑REPAIR ❑RENEWAL FIREDAMAGE []
DEMOLITION
LuAESIOENCE ❑COMM ❑EDUCATIONAL ❑GOV'T 10RELIGIOUSOPATIO `SCAR PORT ❑GARAGE L
STORAGE CISLAB ❑FENCE
❑GOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN ^c`/!cW ❑COUNCIL APPROVED LISIGNS
OCCUPANCY Y--L —LAND USE ZONE H-7 BLDG.TYPE 5N FIRE ZONE-1. PLAN CHECK BY_ tt _ HEAT_ _
to c,n.Aruct addition to rear of* • existimi dwul.linq to consist DF besiroom,
tetLu9mo and family raom ell LjQjk_jW__CgCJa re[auir& .jure tis. _
---F-LQDB B!?_-----_ �1S�L----.-- _.��2.;iLQH� :_ A rm_ NO.j).EQHP_Q.MS____ YALUJ1-, UUQr
JUILDING DEPARTMENT SETBACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit 721000 �--- -
'I THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONIN(
Plan Check 30.00 REGULATIONS AND ALL APPLICABLF CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Subtotal 10240 ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE. OF THIS PERMIT DOES NOT WAIVE
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-- RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 2sB8 LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total ZQ®r Eire
BY_ APl IC ANT OR AGEN!
Approved F'lecelpt No.
ADL)q�55 Pr i()NE
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DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
j2�� a 3-`-29
• to �- 9'' Permit No.
Rough-in
8 yw Fixture
Final
HEATING
Contractor
Permit No.
Gas or Oil
L etr r t_Q_- Rough,-in
Final _
SEWER
l�rY r- Final
DRIVEWAY
Final
Sfw.in Drainage
f
ain Drain Final
dewalk
rb&Street Final
roach
BLDG DEPT. FINAL TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY nal
ndscaping
ning Final
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Address&7. Zo bi i Permit No. �
Name of Occupant larmit charge
_ Connection fee
Paid by_
Date connected—
Type
onnected_Type of Building Inspection
Se►rnice Rate Paid by
Contractor _ Assessment Paid
Size of connection
ear w ear w w W er so as
PERMIT TO CONNECT
City of Tigard 3 —tic" !,
Permit No 881 DATE
PERMIT IS GIVIN TO_�'A.(A t �— .A4 VM
OF--__ --_-
TO CONNECT A
TO THE SYSTEM OF CITY OF TIGARD
AT--- I/ / ,
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON.
NECTION IS MADE AND INSPECTION OF CONNECTION HAS REFN COMPLETED.
PERMIT FBI PAID $ -= p_ CITY OF TIGARD
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CONNECTION (INSPECTED AND APPROVED
W4 Superintendent